COMPEND 



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CUuJuAK 




OF THE 



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EUOE,H£ S. TALBOT, M. D., D. D, S» 








Class fk Vv S2>A 

Book_ l 



Copyright^ . 



COPYRIGHT DEPOSIT. 







QUIZ COMPEND 

ON 

IRREGULARITIES 

OF THE 

TEETH 



TALBOT 



QUIZ COMPEND 



ON 



IRREGULARITIES 



OF THE 



TEETH 



BY 

EUGENE S. TALBOT, M.D., D.D.S. 

Professor of Dental and Oral Surgery, Northwestern University, 
Woman's Medical School 



FIRST EDITION 




CHICAGO 

E. M. Clay & Co. 

103 State Street 

1901 



+VfF UBRARY OF 

Two Co t s Deceived 

NOV. 25 1901 

COPvmoMT ENTRY 

(CLASS CO XXc No., 

1-1 ~) it- 
COPY B. 




Entered according to Act of Congress in the year 1901, by 
EUGENE S TALBOT, 
In the Office of the Librarian of Congress, at Washington, D. C. 






PREFACE 

^T^HE object of this work is not intended 
" to take the place of the larger and 
more complete works, but to be used as a 
primer and reference for advanced students. 
The quiz compend principle has answered 
so excellently in medicine as to entail a 
similar system for dental students. 

Etiology has been discussed at length 
since its knowledge must precede and 
determine the treatment. Questions and 
answers generally prove suggestive to the 
teacher as to new lines of study. 

In the treatment of irregularities of the 
teeth, all forces may be applied individually 
to a given case. The author has inten- 
tionally avoided a discussion of special treat- 
ment since every teacher has of necessity 
his own methods of operation. 



CONTENTS 



Chapter. Page. 

I. History 9 

II. Heredity , 29 

III. Congenital Factors and Maternal Impressions ... 43 

IV. Post-Natal Skull and Jaw Development and 

Periods of Stress 49 

V. Development of the Cranium and Face 63 

VI. Development of the Jaws . , 77 

VII. Development of the Alveolar Process. 85 

VIII. Development of the Vault 89 

IX. Development of the Peridental Membrane 97 

X. Development of the Teeth 101 

XI. Social Consanguinity, Near-Kin, Early and Late 

Marriage 105 

XII. Environment, Climate, Soil and Food 115 

XIII. Race Admixture 129 

XIV. Constitutional Disorders 137 

XV. Intellectual and Moral Defects 147 

XVI. Inter-Operations of Causes and Predispositions. . 149 

XVII. Developmental Neuroses of the Face 157 

XVIII. Developmental Neuroses of the Nose and Interior 

Facial Bones 163 

XIX. Developmental Neuroses ot the Eye 177 

XX. Developmental Neuroses of the Bones of the Ear, 185 
XXI. Developmental Neuroses of the Jaws of the Seem- 
ingly Normal 187 

XXII. Developmental Neuroses of Maxillary Bones 189 

XXIII. Developmental Neuroses of the Vault 195 

XXIV. Developmental Neuroses of the Palate ; . 209 

XXV. Developmental Neuroses in Teeth Position 219 

XXVI. Local Causes of Teeth Irregularities — Upper Jaw, 231 
XXVII. Local Causes of Teeth Irregularities — Lower Jaw, 241 
XXVIII. Local Causes of Teeth Irregularities — Finger- 
Sucking 249 

XXIX. The Degenerate Teeth 253 

XXX. Surgical Diagnosis 269 

XXXI. Physiologic and Pathologic Changes 293 

XXXII. Surgical Correction 303 

7 



Quiz Compend 



ON 



Irregularities of the Teeth 



CHAPTER I. 



HISTORY. 



Q. Is practice of dentistry ancient? 

A. It was a very early specialty of medicine. 
According to Sayce and others, the Assyrians early 
practiced tooth filling with gold, and allied proced- 
ures. 

Q. What was the folklore belief of dental decay? 

A. That it was due to a worm in the tooth. 

Q. Did the Assyrians reach a very high level in 
medicine? 

A. They did not reach a higher level in medicine 
and surgery than that of the Chinese of to-day, who 
are presumably the inheritors of their science. 

Q. What country had attained a relatively high 
status at this early period? 

A. In Egypt nearly every branch of medicine had 
attained a high standard at the time of Herodotus. 

. Q. Do records show that dentistry was practiced 
earlier than this period? 

A. As shown by the Eber's papyrus, dentistry was 
a differentiated specialty of medicine much earlier. 

9 



10 QUIZ COMPEND 

Q. When was gold used? 

A. It was employed by the Egyptians for filling 
teeth as well as for correction of irregularities. 

Q. What evidence is there for this? 

A. Mummies are found containing teeth held in 
place and directed by gold or silver wires or plates. 

Q. What other peoples practiced dentistry in early 
times? 

A. In Hindoo civilization, dentistry early reached 
a high status as a specialty of medicine. Such civiliza- 
tion fell later into decay when the folklore notion of 
disease due to the worm in the tooth resumed its promi- 
nence. 

Q. Was Hippocrates particular in regard to dental 
operations? 

A. Caution was advanced by him in extraction of 
teeth and preserving them. 

Q. What other important point was he critical 
about? 

A. He attacked principally the fetichic origin of 
disease. 

Q. What did this notion lead him to? 

A. As this played a large part in compelling 
unnecessary extraction of teeth, he naturally was led 
to describe the character of teeth and the indication 
for their extraction. 

Q. What important scientist followed him, and 
what great lesson did he teach? 

A. One hundred and sixty years after him Erasis- 
tratus deposited in the temple of Apollo at Delphos an 
odontogogue or leaden tooth forceps, intimating that 
only teeth should be drawn which were loose enough 
to be extracted with this instrument. 



ON IRREGULARITIES OF THE TEETH. 11 

Q. What was the lesson to teach? 

A. This (an ex-voto offering for recovery from 
disease) was probably intended by Erasistratus as a 
popular lesson against too early extraction of teeth. 

Q. Were the Romans influenced by this? 

A. So far as dentistry is concerned, the Romans 
were as much influenced by Etruscan as by Greek cul- 
ture, although the last had a very early influence. 

Q. Were the Etruscans versed in dentistry? 

A. They practiced dental procedures resembling, 
but more complete even than those of Greece. 

Q. Did the Romans early practice dentistry? 

A. In Rome artificial dentures, evidently modeled 
on Etruscan types, were made ere the period of the 
laws of the 4t Twelve Tables." 

O. When did Celsus practice? 

A. He practiced A. D. 30. He was considered 
rather rough in his surgical operations. 

Q. When did Galen practice, and what important 
name did he give to some of the teeth? 

A. Galen practiced 150 A. D. He gave the canine 
teeth the present popular term, eye teeth, because he 
believed they were supplied by the optic nerve. 

Q. What great medical school developed in the 
seventh century? 

A. The Greek, Etruscan, Roman, and Arabian 
culture met at the famous school of Salernum, South- 
ern Italy, which opened 700 A. D. 

Q. Where and when did dentistry advance?. 

A. Under the influence of this school, dentistry 
was practiced more by surgeons and physicians,* 
whereas it had been previously largely confined tQ 
charlatans. 



12 QUIZ COMPEND 

Q. When was the antrum described? 

A. About the middle of the thirteenth century, by 
Bruno of Langoburo, who mentioned various opera- 
tions upon the teeth and antrum nearly four centuries 
before Highmore. 

Q. When was the earliest European attempt to cor- 
rect irregularities of the teeth made? 

A. About the fifteenth century Giovanni d'Arcoli 
filled teeth with gold and made attempts to regulate 
them. 

Q. Where did Shakespeare obtain his observations 
in regard to the teeth? 

A. From the famous anatomy of Helkiah Crooke, 
published in 1618. 

Q. When and by whom was the first French work 
published? 

A. A work called 4l Le Chirurgien Dentiste" was 
published by Fauchard in 1728. 

Q. Who wrote a similar work in French? 

A. Aeubzi, of Lyons. 

Q. Who made the earliest great impression upon 
the profession? 

A. Crooke, who in discussing second dentition, 
remarks that "The shearing (i. e., incisors) teeth, 
when they do break forth, do thrust the first shearers 
out before them and issue betwixt the first two, the 
second and the dog tooth that is next unto them. 
But if the former teeth will not fall or be not pulled 
out, or if the latter issue before the first fall, then the 
latter make their way through new sockets and turn 
in the upper jaw outward, in the lower jaw inward, so 
that there seemed to arise a new row of teeth, and this 
hath deceived many historians and anatomists also." 



ON IRREGULARITIES OF THE TEETH. 13 

Q. Who first mentioned supernumerary teeth? 

A. Barth Ruspini, a century and a quarter after 
Crooke, claimed that all teeth which exceed thirty-two 
may be regarded as supernumerary. In his opinion 
irregularities of the canines and incisors were attribut- 
able to extreme narrowness of the jaws. 

Q. Half a century later what did Robert Blake 
write? 

A. He describes supernumerary and inverted teeth. 

Q. Three decades after what did Joseph Harris and 
Joseph Winckworth remark? 

A. That irregularities were due to supernumerary 
teeth. 

Q. What causes attributable to irregularities, then 
advanced, are still defended? 

A. Among these causes (still in considerable favor 
among dentists, laryngologists and general practition- 
ers) may be mentioned, thucnb-sucking, mouth breath- 
ing and enlarged tonsils. 

Q. What theory was advanced by J. Imrie, six and 
one-half decades ago? 

A. That irregularity is due to want of development 
of the jaw bones, intemperance of various kinds, com- 
bined with artificial modes of living induced by civili- 
zation, and sudden change from heat and cold to which 
the teeth are subject. Rabbit mouth is due to keep- 
ing the thumb in the mouth for hours after going to 
sleep. Underhung jaw is due to sucking the tongue 
which throws the under jaw from its articulation. 

Q. What does he advise about the extraction of 
teeth? 

A. A similar state of the teeth and jaws is induced 
when attempts are made by the inexperienced to 



14 QUIZ COMPEND 

regulate them by extraction of teeth in the upper jaw 
and neglecting to remove an equal number of the 
lower. 

Q. What was J. Lefoulon's opinion? 

A. That the most frequent cause of dental irreg- 
ularities is the neglect of proper supervision of the 
second dentition. 

Q. What did Thomas Ballard claim? 

A. That serrated teeth and projecting jaws were 
the result of fruitless sucking. 

Q. What was Stockton's opinion? 

A. That the cause may be found in the form of the 
palate. Irregularity of position is almost exclusively 
confined to the five anterior teeth on each side of the 
median line brought about by the tongue upon the 
hard palate in sucking or mastication. 

Q. What were Nasmyth's views? 

A. That the projecting upper jaw was due to thumb 
and finger sucking. But when both were involved 
that it was due to arrest of development in the jaw 
where the expansion of the jaw was deficient. 

Q. What changes occurred during the next twenty- 
five or thirty years? 

A. The opinion as to the influence of thumb-suck- 
ing* continued to grow. 

Q. What opinions were prevalent in 1873? 

A. A. A. de Lessert, Thomas Salter and J. W. 
White believed that thuxnb-sucking was the principal 
cause. 

O. How did Francis Fox view irregularities? 

A. That the want of proportion in size of the teeth 
and jaw bones, or prolonged retention of the temporary 
teeth, supernumerary teeth., the habit of thumb-suck- 



ON IRREGULARITIES OF THE TEETH. 15 

ing, undue pressure from a hypertrophied tongue, and 
heredity were the causes. 

Q. What effect did Helkiah Crooke's summary 
have? 

A. His views influenced investigators about a cen- 
tury and a half afterwards. Thomas Berdmore 
claimed that the presence of supernumerary teeth or 
of a double row of teeth is due to the fact that the milk 
teeth are never shed, notwithstanding the fact that the 
permanent teeth appear. 

Q. What did Joseph Fox claim as causes of irreg- 
ularities of the teeth? 

A. That the most frequent cause is a want of sim- 
ultaneous action between the increase of the perma- 
nent teeth and the decrease of the temporary ones by 
the absorption of their fangs, most commonly occa- 
sioned by the resistance of the nearest temporary 
teeth. 

Q. What did Joseph Murphy believe? 

A. That irregularity is due chiefly to the first teeth 
not having been shed in time. 

Q. What are Benjamin James and Parmly's views? 

A. They agree with Murphy. Parmly further says 
that when the permanent teeth are large and growth 
of the jaw does not proceed in a corresponding propor- 
tion, they are found crowded, and overlap each other. 

Q. What did G. White find? 

A. That irregularities of the teeth are mostly occa- 
sioned by the pressure of the temporary upon the per- 
manent, throwing them in the wrong direction. 

Q. What are the views of S. S. Fitch? 

A. Similar to those of Joseph Fox. 

Q. What is the opinion of J. B. Garriot? 



16 QUIZ COMPEND 

A. That the deciduous teeth, by their pressure, often 
prevent the permanent teeth from arranging- them- 
selves in their proper positions. 

Q. What did John Hunter advance as a cause? 

A. That the jaws grow at the posterior edges, and 
that an irregularity is often due to the ten anterior 
permanent teeth being larger than the ten anterior 
temporary teeth, while the corresponding part of the 
jaw is of the same size; therefore in such cases the 
second set is obliged to stand very irregular. 

Q. From observation made upon young pigs, at 
what conclusions did G. M. Humphrey arrive? 

A. That there is no interstitial growth. The five 
permanent teeth occupy exactly the same position 
throughout life and all conditional teeth are added to 
the hind end of the jaw. This hind end is enlarged 
by the absorption of the anterior coronoid edge and 
the deposition on the posterior edge where the molars 
are first formed they are under the coronoid process 
and are frequently exposed. 

Q. What did L. Koecker claim in 1826? 

A. That the deformity which consists in shutting 
the under incisor and cuspidati over the upper, has 
been produced by the injudicious extraction of some 
of the teeth of the upper without taking proper care 
to secure due proportion between the upper and under 
jaw. 

Q. What did Thomas Bell think? 

A. That the most usual cause of permanent irregu- 
larity is the actual want of sufficient room in the jaw 
for the ultimate regular arrangement of the teeth. 

Q. What is Joseph Scott's opinion? 

A. Irregularity arises from, first, a natural want of 



ON IRREGULARITIES OF THE TEETH. 17 

sufficient expansion in the jawbone at the time of 
their protrusion ; second, from not extracting the tem- 
porary teeth at the proper time; third, from too early 
extraction of the temporary teeth; fourth, from super- 
numerary teeth. 

Q. What did John Nicholls find? 

A. That the deformity may be due to too long per- 
sistence of the temporary teeth, or arises from some 
malnutrition of the teeth or jaws, entirely beyond the 
previous control of the dentist. 

Q. What are the views of M. Maclean? 

A. That expansion of the jaw is prevented by 
premature extraction of the temporary teeth. 

Q. What did E. E. Spooner find? 

A. That the first and most frequent cause of irreg- 
ularity is a want of simultaneous action between the 
protrusion of the permanent teeth and absorption of 
the fangs of the temporary. The second cause is a 
narrowness of the maxillary arch, or a want of propor- 
tion between the extent of it and the size of the teeth. 

Q. What theories did William Thornton advance? 

A. That irregularities of the teeth proceed from 
three causes: First, from natural want of sufficient 
expansion in the jawbone at the time of the protrusion 
of the teeth, second, non-extraction of temporary teeth 
at the proper time ; third, too early an extraction of 
the temporary. 

Q. What views did Mortimer have? 

A. That irregularities of the teeth arise from 
natural and accidental causes. Natural causes arise from 
the bad conformation of the jaw, so that several teeth 
are over each other; from the teeth being much 
larger than they should be; from coming out of order 

2 



18 QUIZ compe'nd 

and place; from teeth growing out of the plate or pro- 
jecting out of the mouth. Accidental causes arise from 
neglect or ignorance in removing milk teeth too soon, 
when the second teeth take a direction inward or 
outward from some internal cause; underhung jaws 
arise from making faces. 

Q. What theories did Charles de Loudes advance? 

A. That irregularities are. due to supernumerary 
teeth, to second teeth being large and maxillary arch 
too narrow, to early extraction, to too long persistence 
of the temporary teeth, to shape of the maxillary arch, 
and to heredity, where the child inherits the jaw of one 
parent and the teeth of another. 

Q. What views did Samuel Ghimes suggest? 

A. He spoke of the underhung jaw being due to 
the upper incisors extending inwards, and in closing 
the mouth, they come in contact with the lower. This 
makes the child incline to protrude the lower jaw, 
which finally becomes habitual and promotes the in- 
crease in the length of the jaw itself. 

Q. To what does Nessel attribute irregularities? 

A. To the premature extraction of the temporary 
teeth. The alveoli form a bone scar in such cases, 
which constitutes an obstacle to the advancement of 
the permanent teeth. In consequence, the permanent 
teeth come before the jaw is sufficiently expanded to 
receive them. 

Q. Between what years was the theory of mouth 
breathing most prevalent? 

A. Between i860 and 1880, mouth breathing, espe- 
cially during sleep, formed a prominently discussed 
etiologic factor. 

Q. What was Tomes' opinion? 



ON IRREGULARITIES OF THE TEETH. 19 

A. That deformity of the jaws is often caused by 
sleeping with the mouth open. 

Q. What did Catlin, the ethnologist, claim? 

A. He made popular propaganda in favor of nose 
breathing, and ascribed many diseases to keeping the 
mouth open. Malformation of the jaws and teeth 
were due to keeping the mouth open, since civilized 
man is the only animal who keeps his mouth open 
during sleep. This view still meets with much favor 
among dentists and laryngologists. It is, however, 
losing cast with paediatricians. 

Q. Sixteen years after Catlin, what views were 
advanced by W. Mathews? 

A. Irregularities were attributable to enlarged 
tonsils, which necessitated breathing being carried on 
with the mouth open. They were also due to heredity. 
The maxilla was smaller in proportion than the teeth, 
owing to the lessened work of the jaws and teeth among 
civilized races. Cross breeding played an important 
part, as did thumb-sucking and lip-sucking; retarded 
shedding of the temporary teeth and too early extrac- 
tion of the first permanent molars. The congenital 
V-shaped jaw is that formed where, previous to birth, 
the type of upper maxillae is such that its cornua do 
not diverge posteriorly, but are parallel. As that por- 
tion of the jaw already formed never changes its form, 
the newly added parts will pass off in divergent lines, 
forming an angle with that previously existing in order 
to correspond with the increasing width of the base of 
the skull. The growing tendency exhibited from the 
time of Crooke to assign constitutional factors import- 
ant places in the etiology of the teeth and jaw irregu- 
larities is noticeable in Mathews. He, while laying 



20 QUIZ COMPEND 

stress on local factors, was forced to recognize the 
importance of constitutional factors. Constitutional 
factors hence early began to assume considerable 
importance. John Fuller, while attributing, in 1810, 
irregularity to long persistence of temporary teeth, 
also remarked that the upper jaw is often too small 
for the permanent teeth, this condition frequently 
resulting in its irregularity. 

Q. What w r as Sigmond's opinion? 

A. That irregularities are due to natural and acci- 
dental causes. Causes are natural, (1) when they 
result from the jaw not expanding sufficiently to allow 
the teeth to form a regular circle; (2) when they are 
larger than the ordinary dimensions; (3) when they 
do not appear in their proper order and place. Causes 
are accidental when due to negligence or improper 
treatment at the time of growth. 

Q. What views did Andrew Clarke advance? 

A. That irregularity of the teeth is occasioned by 
want of room in the jaw and not from any effect that 
the first set of teeth may produce upon them, is evident 
from the fact that in all cases of irregularity, there is 
not room to admit of placing the teeth properly. 

Q. What were those of J. P. Clarke? 

A. That irregularity may arise from too premature 
extraction of temporary teeth. Disproportion 
between the teeth and jaws may be occasioned by a 
natural conformation of the parts, or may be the effect 
of unnoticed accident. For we seldom found any such 
disproportion and consequent irregularity in the teeth' 
of men and animals in a wild state. 

Q. What was William Robertson's hypothesis? 

A. That deformity is due to inheritance of the con- 



ON IRREGULARITIES OF THE TEETH. 21 

tracted jaw of one parent and the large teeth of the 
other. 

Q. What did David W. Jobson suggest? 

A. That irregularity is due to smalfeiess of the 
maxillary arch and the great size of the permanent 
teeth, and to their situation, part on the inner and of 
others on outer side of permanent teeth. 

Q. What was John Mallan's theory? 

A. That the adult teeth being larger as well as 
more -numerous than the milk teeth, it is obvious that 
they require a great deal more room, and when the 
absorption of the latter does not progress equally with 
the growth of the former, the new teeth are crowded 
up and are apt to be forced out of their natural posi- 
tion by the resistance of the old. Again, if the per- 
manent prove, as they sometimes do, disproportionately 
large in comparison with their predecessors, the jaw 
may not be sufficiently extended to admit of their 
being arranged in order, in which case some overlap 
the others and considerable deformity is occasioned. 

Q. What was Maury's theory? 

A. That the prominence of the upper jaw is due to 
narrowness of the arch; recession to the anterior 
teeth. 

Q. What suggestion did C. H. Harris make? 

A. That infringement of the laws of growth or 
disturbance of the organs of the face or head may 
determine improper development of the jaws and bad 
arrangement of the teeth. Irregularity of the teeth 
is due to narrowness of the maxillary arch and some- 
times to the presence of the temporary teeth. 

Q. What does W. K. Brideman suggest? 

A. That the tongue, lips and cheek exert no influ- 



22 QUIZ COMPEND 

ence in moving the teeth from their original direction. 
This is due to the shape of the jaw. 

Q. What is Sam Harbert's theory? 

A. That irregularities of the teeth are due to pre- 
mature extraction of the deciduous teeth and protru- 
sion of the permanent before the absorption of a 
deciduous fang. A projection of the lower jaw is 
attributable to neglect in second dentition. Generally 
it is supposed to be due to elongation of the jaw, which 
is almost always an error. When the dental arch 
becomes contracted at the medial line, giving to the 
mouth a pointed appearance, it is often the result of 
premature extraction of temporary teeth. 

Q. What is Alfred Canton's opinion? 

A. That irregularity of teeth as regards shape, 
position, direction, crowded condition, etc., is met 
with more frequently than is supposed to be the case. 
The causes are chiefly mechanical, depending either on 
the non-increase in size of the jaw in proportion to the 
growth of the teeth to be contained in the alveolar 
arch; on the position of the permanent teeth with ref- 
erence to the fangs of their predecessor, and lastiy, on 
the increase in size of one jaw in preference to the 
other. 

Q. What is C. F. Delabarre's opinion? 

A. That malformation of denture may be occa- 
sioned by defective conformation of the jaw; by simple 
arrest of development dependent upon the health of 
the individual; by excess of development of the teeth, 
though the jaws be in other respects well formed; by 
rapid development in the dentition of one set, and 
delay in that of the other; by the too great size of the 
teeth of one jaw, which do not harmonize with those 



ON IRREGULARITIES OF THE TEETH. 23 

that are opposite. Some forms of defective palatine 
arches are hereditary. 

O. What was J. R. Duval's opinion? 

A. That in a projecting chin, the alveolar arch, in 
which the incisors and canines are placed, has taken 
a development upon a parabolic line — greater and 
more prominent than that presented by the bone. 
This differs very little from a similar one in the upper 
jaw, which projects over the lower. Upon 'attention 
to shedding of the temporary teeth depends the fine 
arrangement of the lower. 

Q. What was Gunnell's opinion in regard t<3 pro- 
trusion of the lower jaw? 

A. That while in many cases hereditary, it is often 
brought about in the following manner: The incisors 
of the lower jaw are cut first, and when the upper 
ones appear, the lower have nearly arrived at full 
growth. In closing the mouth, they come in contact 
with the gum on the inside of the upper incisors, and 
for relief the lower jaw is thrust out, which condition 
soon becomes permanent. 

Q. W r hat was the opinion of Samuel Cartwright, Jr. ? 

A. That irregularities of the permanent are due, 
first, to non-absorption of the roots. of the temporary 
teeth in proportion to the rise of those of replacement. 
Second, to the great difference which commonly exists 
in the size of the new teeth as compared with those of 
the first set. Third, to contraction of the arches of 
the jaws and other malformations of the maxillary 
and palate bones originating in hereditary, congenital, 
and other causes. 

Q. What were the conclusions of Messrs. Mummery 



24 QUIZ COMPEND 

and Nichols, in i860, after observations upon the teeth 
of primitive races? 

A. They found that irregularities of the teeth, and 
contracted jaws, were rare. 

Q. What did Messrs. Coleman and Cartwright's 
observations show? 

A. That the primitive skulls in Kent, England, had 
well developed jaws and alveolar arches. The teeth 
still present were remarkably regular. 

Q. What opinion did Samuel Cartwright express 
in 1864? 

A. That irregularities result from selective breed- 
ing; that they both are congenital and hereditary; 
that there is very little increase in the anterior part of 
the jaw after eight or ten years; that if the tem- 
porary teeth were to remain, the jaws would not 
change from those of childhood; that in all cases 
irregularity of the maxillae are more or less altered in 
proportion of development, whilst the teeth maintain 
in regard to size an average development. 

Q. What did A. A. Blount suggest? 

A. That the remote causes which produce irregu- 
larity will be found in the commingling of all nations 
with national and individual characteristics. The 
most frequent causes are the result of accident, indis- 
criminate action of the deciduous teeth, and too early 
extraction of the permanent teeth. 

Q. What did H. Sewell suggest? 

A. That protrusion of the incisors is apparently 
due to an abnormal development of the maxillary 
bone. Irregularities are due to retention of temporary . 
teeth, causing permanent teeth to assume an un- 
natural position; also to malformation of the jaw, 



ON IRREGULARITIES OF THE TEETH. 25 

which is usually congenital and at the same time 
hereditary. They may be due, however, to injury and 
to accidental causes. 

Q. What did J. L. Down find? 

A. That excessive vaulting of palate is due to 
arrest of development of the sphenoid or defective 
growth of the vomer. The defects are development 
defects, and betoken a cause long anterior to the time 
when sucking the thumb is practiced, unless that habit 
be an intra-uterine one. 

Q. To what does Kingsley attribute irregularities? 

A. Irregularities are attributed chiefly to prema- 
ture extraction of temporary teeth, marriage between 
persons of different nationalities, heredity, or dis- 
turbed innervation. 

Q. What is S. H. Guilford's division? 

A. Hereditary and acquired. 

Q. What did the author conclude in 1880? 

A. That the shape and size of the jaws may be 
inherited, but the manner of the eruption of the teeth 
is not transmitted, hence irregularities of the dental 
arch per se are not inherited. 

Q. What other point did he settle? 

A. That the muscles of the mouth and cheeks have 
nothing to do with the production of the V-shaped or 
saddle arch or their modifications. 

Q. What was shown? 

A. That the only tissues involved in the production 
of irregularities are the teeth on the one hand and the 
jaw bone and alveolar process on the other; that the 
incisors in the V-shaped arch always protrude, and 
never in the saddle; that the manner of the forma- 
tion of irregularity is in the arrangement of the teeth 



26 QUIZ COMPEND 

(no matter what position the teeth take, the alveolar 
process builds itself about them to hold them in posi- 
tion) ; that there is a decided difference between the 
deformities produced by thumb-sucking in its various 
forms and the V and saddle arches. Owing to the jaws 
being transitory structures with an unstable nervous 
system, excessive and arrest of development takes 
place. One jaw may be excessive, the other arrested. 

Q. What are some of the causes of an unstabl 
nervous system? 

A. Debilitating, acute diseases of children are 
noticeably often followed by sudden overgrowth or 
undergrowth of bone. Cases of pneumonia and 
measles are followed by dental and maxillary deform- 
ities. Inherited or acquired neuropathic states are also 
evinced at the periods of stress marked by dental 
evolution or involution. Irregularities are due to con- 
stitutional origin, developing with the osseous system, 
and to local origin. Irregularities cannot occur until 
the teeth have erupted (as nothing can exist except it 
be present). This shows their relation to each other 
and to the jaw. Deformities always commence at the 
sixth year, and are completed by the twelfth. The 
forward movement of the posterior teeth produce the 
same results as arrest of development of the maxilla. 
The vault is not contracted by mouth breathing. Con- 
tracted arches are as common among low vaults as 
high, but appear high because of the contraction. 
Mouth breathing (due to hypertrophy of the nasal 
bones and mucous membranes, deformities of the nasal 
bones, adenoids, or any pathologic condition producing 
stenosis) does not cause contracted jaws, but like V ^-se 
is due to neuroses of development. 

Q. What is Colyer's summary? 



ON IRREGULARITIES OF THE TEETH. 'IT 

A. The opinion of previous writers into the state- 
ment that the causes which produce irregularities of 
the teeth are general and local. 

Q. In 1901, to what did Arbuthnot Lane call atten- 
tion? 

A. To the association of deformities of the alveolar 
process and constitutional deficiencies (like those of 
the chest) referring the deformities to the action of 
local factors and ignoring the underlying constitu- 
tional element. 

Q. Give a summary of the theories in the order in 
which they have been advanced to 1880. 

A. Irregularities of the teeth were early recog- 
nized and attempts made toward correction. Irregu- 
larities were charged: To too long retention of the 
temporary teeth, too early removal of the temporary 
teeth, to supernumerary teeth, narrow jaws, inverted 
teeth, thumb-sucking, mouth-breathing, enlarged 
tonsils, want of development of the jaw bones, intem- 
perance, heat and cold, sucking the tongue, extracting 
teeth on the upper jaw and neglect to extract the 
same number on the lower, the influence of the 
tongue, lips and cheeks, the form of the palate, tongue 
hypertrophy, heredity, too great permanent teeth for 
the space, pressure of the temporary against the per- 
manent, want of interstitial growth, from removal of 
the temporary teeth (the bone scar prevents the per- 
manent teeth from erupting regularly) sleeping with 
the mouth open, cross breeding, constitutional factors, 
congenital states, early decay and loss of the tempo- 
rary teeth, non-absorption of the roots of the tem- 
porary teeth, selective breeding, arrest of development 
of the sphenoid or defective growth of the vomer, 
artificial life, disturbed innervation. 



CHAPTER II 



HEREDITY. 

Q. What are L,uys' views as to heredity? 

A. That the individual that comes into the world 
is but one link in a long chain which is unrolled by 
time, and the first links of which are lost in the dim 
past. 

Q. What are the antecedents of the individual? 

A. He has not merely two parents but the ancestors 
behind him. 

Q. Do these ancestors represent the same, or differ- 
ent types? 

A. These two parents may represent ancestors of 
very different types, whose qualities, seemingly absent 
in the parent, v/ill appear in the descendant. 

Q. Do the relative functions of the sexes become 
a factor? 

A. They are a potent factor to be taken into consid- 
eration in estimating its influence. 

O. What part does the female play? 

A. The original function of reproduction, that of 
cell division, is the part of the female. 

Q. What part does the male play? 

A. The male in the lower types of life (some plants 
and infusoriae) simply supplies the female with nour- 
ishment. 

Q. What happens with rise in evolution? 

A. The protoplasm is differentiated. 

Q. Which furnishes the type? 

29 



30 QUIZ COMPEND 

A. The female, which is the best capable of devel- 
opment, and which is properly nourished by a highly 
developed male. 

Q. Which produces the greatest influence in the 
offspring? 

A. As the product of fructification is longest under 
the nutritive influence of the female, her influence is 
most potent in redeeming defects or producing them. 

Q. Are results identical from parent to child? 

A. It is an incorrect conception of the law of 
heredity that looks for identical phenomena in each 
succeeding generation. 

Q. What views have been expressed if the mental 
characteristics of the child be not similar to the 
parent? 

A. Some have refused to admit that mental facul- 
ties were subject to heredity, because the mental char- 
acteristics of the descendants were not precisely those 
of the progenitors. 

Q. On what grounds? 

A. That each generation must copy the preced- 
ing. Father and son must present the spectacle of 
one being having two births and each time leading the 
same life under the same conditions. 

Q. Where must the application of the law of hered- 
ity be sought? 

A. It is not in the heredity of function or of organic 
or intellectual facts that the application of the law of 
heredity must be sought, but at the very fountain 
head of the organism in its inmost constitution. 

Q. How is heredity divided? 

A. Direct, indirect and telegony. 

Q. What is direct heredity? 



ON IRREGULARITIES OF THE TEETH. 31 

A. Direct heredity consists in the transmission of 
paternal and maternal qualities to the children? 

Q. How is this divided? 

A. This form has two aspects. The child takes 
after the father and mother, equally as regards both 
physical and moral characters, a case, strictly speaking, 
of very rare occurrence; (2) or a child, while taking 
after both parents, more especially resembles one of 
them. 

Q. What distinction must again be made between 
two cases? 

A. The first of these occurs when the heredity takes 
place in the same sex from father to son or from 
mother to daughter. 

Q. What is the other form? 

A. The other, which is more frequent, appears 
when heredity occurs between different sexes, from 
father to daughter, or from mother to son. 

Q. What is reversed heredity, or atavism? 

A. It consists in the reproduction, in the descend- 
ants, of the moral or physical qualities of their ances- 
tors. 

O. How does this occur? 

A. It frequently occurs between grandfather and 
grandson, as well as between grandmother and grand- 
daughter. 

Q. What is collateral or indirect heredity? 

A. It is of rarer occurrence than the foregoing, and 
is simply a form of atavism, which subsists as indi- 
cated by name between individuals and their ancestors 
in the direct line — uncle or granduncle and nephew, 
aunt or niece. 

O. What is telegony, or the heredity of influence? 

3 



32 QUIZ COMPEXD 

A. It consists in reproduction in the children by a 
second marriage of some peculiarity belonging to a 
former spouse. 

Q. Do morbid parents always have morbid 
children? 

A. The descendants of a victim of morbidity or 
abnormality do not always exhibit the morbidity of 
abnormality of the parent. 

Q. Is morbid heredity ever wanting? 

A. It is most often not present to the full extent. 

Q. Is it not sometimes slight in the child? 

A. Frequently slighter abnormalities than those in 
the parent may be detected. 

Q. What two independent principles are here 
evident? 

A. The transmutation of heredity and the atavism 
upon which it depends. Atavism at times tends to 
preserve the type and offsets the influence of degen- 
eracy. 

Q. What does it underlie? 

A. Not merely the production of the sound action 
of degenerate stock, but also those in whom the 
degeneracy affects the earlier, and not the later, ac- 
quirements of the race. 

Q. What direction does manifestation of morbid 
heredity take? 

A. The line of least resistance. 

Q. What is the extent and direction of the line of 
least resistance? 

A. It depends upon the amount of healthy atavism 
which separate organs and structures of the body pre- 
serve. 

Q. Is this also true of the cells forming its organs? 



ON IRREGULARITIES OF THE TEETH. 33 

A. What is true of the organism as a whole is also 
true of the cells forming its organ. 

Q. Is there a struggle for existence on the part of 
the cells? 

A. While cell life is altruistic or subordinate to the 
life of the organ and through it to the life of the organ- 
ism as a whole, still this altruism is not so complete 
as to prevent entirely a struggle for existence on the 
part of the cells or individual organs. 

Q. Does this struggle increase, or decrease? 

A. With advance in evolution this struggle de- 
creases, to increase with the opposite procedure of 
degeneracy. 

Q. What is the result? 

A. From it results the phenomena of arrest and 
excessive development. 

Q. By whom was this struggle for existence pointed 
out? 

A. It was first pointed out by Aristotle, who 
showed that one organ w r as often sacrificed for the 
development of another. 

Q. Was this more clearly pointed out later? 

A. It was, and freed from obscurity by Goethe in 
1807, and St. Hilaire in 1816. 

Q. What is this law called? 

A. The law under which the struggle operated is 
known as the law of economy of growth. 

Q. How does it operate? 

A. Its action sometimes aids, sometimes repels 
and prevents degeneracy. 

Q What did VonBaer point out? 

A. That the vertebrate embryo of the higher type 
has in it all the potentialities of the organs and struc- 

3 



34 QUIZ COMPEND 

tures found in lower types, therefore, in proportion 
as the ancestry is strengthened do these potentialities 
remain latent. 

Q. What is the reverse? 

A. In proportion as the ancestry becomes a subject 
of nervous exhaustion these potentialities gain nutri- 
tion at the expense of the later acquired organs, which 
are the ones likely to be affected by nervous exhaustion. 

Q. Have all the organs of the body their own 
nervous system? 

A. Practically they have, and it exercises a control 
over their nutrition through its influence on the blood 
supply and the means of excretion. 

Q. How are these local actions regulated? 

A. By the control of the nervous system for the 
benefit of the organism as a whole. 

Q. What results when the central nervous system 
becomes involved? 

A. When the central nervous system becomes 
weakened, the local nervous system given free play 
first draws greater nourishment and increased power 
and thereby becomes itself exhausted and a struggle 
for existence occurs between its parts. 

Q. What results? 

A. As in the case of tumors and cancers, cells take 
on the power of reproduction, which for a long time 
they had lost for the benefit of the organism as a 
whole. 

Q. What effect has this struggle for existence? 

A. It produces effects which are handed down by 
heredity or are fought by atavism. 

Q. Are these factors a benefit, as well as a detri- 
ment? 



ON IRREGULARITIES OF THE TEETH. 35 

A. It is obvious, therefore, that these two factors 
in heredity may play beneficial as well as injurious 
parts on the offspring. 

Q. What effect does atavism have upon deformities? 

A. As a rule atavism plays a beneficial part in 
correcting degenerate tendencies. 

Q. To what extent may this be carried? 

A. It may either be complete in the shape of a per- 
fect return to a normal ancestor or may be so incom- 
plete as to moderate in the offspring the extended 
nervous exhaustion which his ancestor has trans- 
mitted. 

Q. What are the biologic effects of degenerative 
forces on heredity as shown by Moreau (de Tours) ? 

A. First, absence of conception ; second, 
retardation of conception; third, imperfect conception ; 
fourth, incomplete products (monstrosities); fifth, 
products whose mental, moral and physical constitu- 
tion is imperfect; sixth, products specially exposed to 
nervous disorders in order of frequency, as follows: 
Epilepsy, imbecility, idiocy, deaf-mutism, insanity 
and other cerebral disorders; seventh, lymphatic pro- 
ducts predisposed to tuberculosis and allied disorders; 
eighth, products which die in infancy in a greater pro- 
portion than sound infants under the same conditions; 
ninth, products which, although they escape the stress 
of infancy, are less adapted than others to resist dis- 
ease and death. 

Q. Are there more stillborn children? 

A. There are more deadborn children in plural 
pregnancies and children born alive are more difficult 
to rear. 

O. What are Ansell's views as to this matter? 



36 QUIZ COMPEND 

A. The proportion of infants stillborn or dying soon 
after birth is, in the case of males, nearly five times, 
and in the case of females, nearly four times, greater 
in multiple than in single births. 

Q. What did J. M. Duncan find? 

A. Pluriparity is especially associated with idiocy 
and imbecility and it especially affects the sterile ages 
or the ages of weakness of reproduction. 

O. What did Arthur Mitchell show? 

A. That among imbeciles and idiots a much larger 
proportion is found to be twin-born than among the 
general community. 

O. What was observed among relatives of imbe- 
ciles and idiots? 

A. That twinning is very frequent. 

Q. When twinning is frequent, are deformities 
common? 

A. Bodily defects likewise occur frequently. 

Q. What effect does twinning have upon the econ- 
omy? 

A. It indicates imperfect development and feeble 
organization of the product. 

Q. What did Herbert Spencer show? 

A. That with increase in growth and specialization 
must occur decrease in the explosive manifestations 
of life. 

Q. What effect has this on reproduction? 

A. Among these explosive manifestations in early 
biologic history is the function of reproduction, which 
is common to all cells. 

Q. What occurs with advance of evolution? 

A. The functions of cells become specialized and 
the extent of reproductive power decreased. 



ON IRREGULARITIES OF THE TEETH. 37 

Q. What did Spencer call this specialization? 

A. He designates it individuation. 

Q. What effect does degeneracy produce? 

A. The organism returns to the lower type and 
consequently tends to reversion of individuation. 

Q. What results? 

A. First occurs absence of conception to which 
Moreau de Tours refers. 

Q. What happens if the organism be less affected? 

A. -The plural and frequent repeated births of 
degeneration occur. 

Q. Are abortions more frequent in plural births? 

A. They are comparatively more frequent than in 
ordinary pregnancies. 

O. Are monstrosities common? 

A. Monstrosities of all kinds are more common in 
plural than in ordinary pregnancies. 

Q. How is it shown that twinning, triplets, etc., 
are a departure from the physiologic rule? 

A. Everything known concerning triplets and 
quadruplets supports the opinion derived from twins. 

Q. What observations support these views? 

A. Valenta's, who observed two epileptics (mother 
and daughter) who illustrated this very decidedly. 
The mother had thirty-eight children, six times twins, 
four times triplets, and twice quadruplets. The 
daughter, at the age of forty, had thirty-two children, 
three times twins, six times triplets and twice quad- 
ruplets, and Kiernan, who found that ninety families 
of degenerates averaged eleven children each. Trip- 
lets, quadruplets and twins were more than ten times as 
frequent as among the population taken as a whole. 

Q. What inference results from this? 



38 QUIZ COMPEXD 

A. That occurrence of large families should be 
regarded, not as an expression of advance, but of degen- 
eracy. 

Q. How is the status in evolution determined by 
pr6geny? 

A. When multiple and frequent progeny occur in 
a family, the condition must be regarded as a trans- 
formation of malign heredity. 

Q. What results from these conflicting factors? 

A. That direct heredity is rare, and that acquired 
influences are apt to expend their force upon unstable 
structures, most subject to the struggle for existence 
occurring within the organism. 

Q. Are the skull, jaws and teeth liable to this pre- 
disposition? 

A. Their instability predisposes them to the strug- 
gle, and hence renders them peculiarly liable to the 
ply of hereditary influences or acquired defects of an 
ancestor. 

Q. How does heredity act? 

A. It "merely furnishes, in case of the jaws and 
teeth, powder to be lighted up by factors locally applied 
during periods of stress after birth. 

Q. Without these locally applied excitants, what 
would result? 

A. The types usually ascribed to heredity by 
dentists will not occur. 

Q. What furnishes the match? 

A. Environment furnishes the match, but it makes 
a great difference whether, as Havelock Ellis says, the 
match be thrown into a powder magazine or the sea. 

O. What is Weismann's position? 

A. He denies the inheritance of acquired defects. 



ON IRREGULARITIES OF THE TEETH, 39 

Q. Has he modified his opinion since making the 
statement? 

A. An attempt to transfer his position from the 
domain of biology to that of pathology led him to 
encounter facts he was obliged to explain in a manner 
inconsistent with his original position. 

Q. What are his latest views? 

A. He admits the origin of a variation equally 
independent of selection, and amphimixis is due to 
constant occurrence of slight inequalities of nutrition 
of the germ plasm. 

Q. Do these variations accumulate? 

A. These variations are at first infinitesimal, but 
ma} r accumulate, and in fact they must do so when 
the modified conditions of nutrition which give rise 
to them have lasted for several generations. 

Q. Upon what, according to Weismann, does indi- 
vidual variability depend? 

A. Individual variability, according to Weismann, 
cannot be charged to direct action of external influ- 
ence upon the germ cells and their contained germ 
plasm, since these are very difficult to change, yet he 
admits that this structure may possibly be altered by 
influences of the same kind continuing for a very long 
time. 

Q. Why does Weismann claim that the causes of 
inheritable differences must be sought elsewhere than 
in these varying influences? 

A. Influences which are mostly of variable nature, 
tending now in on9 direction, now in another, as they 
do not act continuously, can hardly produce a change 
in the structure of the germ plasm. 

O. What does Weismann admit as to birth marks? 



40 QUIZ COMPEND 

A. That there are a number of congenital deform- 
ities, birthmarks and other individual peculiarities, 
which are inherited. 

Q. Are these, according to Weismann, acquired 
characters? 

A. Yes. 

Q. What was their origin? 

A. They must have once appeared for the first 
time. 

Q. What, according to Weismann, caused them? 

A. At least a great proportion of them proceed 
from the germ itself, and must, therefore, be due to 
alteration of the germinal substance. 

Q. How, according to Weismann, must the inher- 
itance of acquired characters be proven? 

A. If any of these hereditary deformities originate 
in the action of some external cause upon the already 
formed body (soma) of the individual and not upon the 
germ cell, then the inheritance of acquired characters 
is proven. 

Q. How does Weismann show that such heredity 
of acquired characters occurs? 

A. By admitting that tuberculosis may produce 
what he calls a k4 habit" "in the ancestor, which may 
be transmitted to the descendants. This habit con- 
sists in the formation of structural peculiarities, such 
as narrowness of the chest, etc.' 1 The admission of 
such a 4l habit' ' offsets any denial of the inheritance of 
acquired characters. 

Q. Have recent investigations sustained the dis- 
tinction between the germ and body plasm? 

A. They have destroyed the embryologic distinc- 
tion between the germ plasm and the body plasm and 



ON IRREGULARITIES OF THE TEETH. 41 

disproved the claim that the first division of the cell 
represented separation of body plasm and germ plasm. 

Q. How often may these cells be divided before 
they can pursue a separate existence? 

A. They may be divided twice, four times, and 
even sixteen times, if disassociated for growth, before 
separate cells can become well developed organisms of 
the parent type. 

Q. What do experiments in production of double 
monstrosities show? 

A. They long ago cast suspicion upon the embryo- 
logic position of Weismann. 

Q. Of what value have been his researches? 

A. They have done undeniable good in destroying 
loose notions as to direct heredity previously present. 



CHAPTER III. 



CONGENITAL FACTORS AND MATERNAL IMPRES- 
SIONS. 

Q. Can all abnormal conditions associated with the 
child at birth be considered inherited? 

A. Hereditary influences must be separated from 
factors occurring during one pregnancy which affect 
the product of that pregnancy alone. 

Q. What are these factors? 

A. These are the factors causing " maternal impres- 
sions," or so-called mother's marks and other defects. 

Q. What are maternal impressions? 

A. Maternal impressions have been excellently 
illustrated by a case reported nearly two decades ago 
by T. C. Poole, of Mansfield, Texas. His sow gave 
birth (April, 1883,) to eight fully developed pigs. The 
ninth had the appearance of an elephant. It was 
destitute of hair, had dependent ears, a proboscis, two 
eyes behind upper -two-thirds of proboscis, closely 
approximated, yet distinct, an abnormal superior 
maxillary, containing three large teeth with a long, 
thin upper lip of elephantine shape and color. The 
sow's gestation lasts three months and twenty days. 
On Christmas day, 1882, the boar was with her. 
December 29th, a menagerie had an elephant staked 
about three hundred yards from where the sow was, 
and in full view. 

Q. What were the causes of this " maternal impres- 
sion?" 

43 



44 QUIZ COMPENT) 

A. The pig descending from the proboscidea, has, 
at one stage in intra-uterine development, a proboscis, 
whose musculature is still retained by the adult pig, in 
whom the nose plays, to some extent, the part of a 
hand for rooting purposes. The cause was, therefore, 
arrested development at the period of pig intra-uterine 
development when the proboscis existed. This arrested 
development could have arisen from nervous shock to 
the sow alleged, since these animals are easily upset 
during gestation. 

Q. What are the usual views of maternal impres- 
sion causes? 

A. Maternal impressions have been considered 
from one standpoint only, and that is as to their sup- 
posed cause and its method of action. As the supposed 
cause is psychic and— in the conception of it usually 
adopted — immaterial in action, an absurd credulity 
respecting its pow T ers, which existed at one time among 
obstetricians, has given way to an equally absurd skep- 
ticism. 

Q. Do maternal impressions occur from mental 
photograph? 

A. Specimens exist of newly-hatched chicks with 
a curved beak, like a parrot, and the toes set back, as 
in that bird. The hens in the yard, where these mon- 
strosities were hatched, had been frightened by a 
female parrot, which, having escaped, fluttered among 
them before the eggs were laid, and greatly frightened 
the hens from whose eggs the malform chicks were 
hatched. This seems to confirm the photographic 
theory of maternal impressions; but these malforma- 
tions are simply arrests of development, since birds are 
aberrant reptiles belonging to the sauropsidae, and 



ON IRREGULARITIES OF THE TEETH. 45 

during their embryonic development pass through the 
reptilian phase. 

Q. In a general way, how may alleged mental im- 
pressions be divided? 

A. Into two classes. First, those in which an 
arrest of embryonic development has occurred, which 
may or may not be traceable to the alleged impression. 
Second, photographic impressions charged to a factor 
utterly incapable of producing them, because of the 
late period in embryonic life at which the impres- 
sion is alleged to have acted. 
* Q. How do mental shocks act on the organization? 

A. In a purely physical manner. Since all that is 
known of the mind is known of it as related to the 
purely physical conditions through which it acts, 
whether its action be initiated by conditions affecting 
physically the various sense organs or not. 

Q. Does the foetus react to mental influence on the 
mother? 

A. It often exhibits very decided reaction to sen- 
sory impressions on the mother, whose dreams affect 
the foetus. Even ordinary dreams of moderate excit- 
ation, not interrupting sleep, may produce foetal 
movements. These dreams need not take the night- 
mare type, though such dreams would cause sudden 
contraction, under the influence of a terrifying idea, 
with the resultant cardiac disorder. 

Q. What effect may these maternal mental changes 
have upon the foetus? 

A. Mental changes of the mother excite motor 

reaction in the foetus, and, as with sensorial excitation, 

these reactions are stronger in the foetus than in the 

mother. 
4 



46 QUIZ COMPEND 

Q. How do these motor reactions act? 

A. The mechanism of these motor reactions is 
obviously the unconscious and involuntary movement 
of the uterine walls. 

Q. Can the statistic method of proof be applied to 
maternal impressions? 

A. Yes. Of 92 children born in Paris during the 
siege, 64 had slight mental or physical anomalies, the 
remaining 27 were all weakly, 21 were imbecile or 
idiotic, and 8 were normally insane. 

Q. What were they called? 

A. These figures led the working class of Paris to 
call children born in 1871 ''doomed children." 

Q. What effect had the financial crisis of 1875-1880, 
in Berlin? 

A. It was followed by an increase in the number 
of idiots born. 

Q. What effect has profound mental shock? 

A. It can alter nutrition so that the mother shall 
furnish poisonous products in lieu of nutrition. 

O. How will these affect the foetus? 

A. Such poisonous products would tend to check 
foetal development. 

Q. While science rejects the photographic phases 
of maternal impressions, what does it admit? 

A. It admits that a class of causes of arrested devel- 
opment exists, due to the effects of mental shock upon 
the mother. 

Q. What structures are most liable to be affected 
by shock? 

A. Structures variable in evolution. 

Q. What may they be? 

A. This influence most strongly affects nutrition of 



ON IRREGULARITIES OF THE TEETH. 47 

the dermal bone elements of the skull and jaws, and 
hence must affect the teeth. 

O. When will the results be manifested? 

A. The results of this will not always be obvious 
until the periods of stress. 

Q. What is one dental result of foetal arrested 
development? 

A. One expression of foetal senescence is the child 
born with teeth. 

Q. When does this occur? 

A. This occurs under the law of economy of growth 
in connection with arrest of development at the sen- 
ile period of foetal development, four and one-half 
months. 

Q. What grave deformity is frequently found with 
premature eruption of the teeth? 

A. Cyclopia and grave brain degeneracy. 

Q. Was the connection between degeneracy and 
teeth at birth very early observed? 

A. It was since Shakespeare makes Richard III. 
remark : 

" The midwife wonder'd and the woman cried, 
O Jesu, bless us, he is born with teeth*. 
And so I was; which plainly signified 
That I should snarl and bite and play the dog." 

Q. Are ante-natal teeth rare? 

A. They are not. The significance of natal erup- 
tion of teeth is not that of vigor; many of the subjects 
succumb early in life. 

Q. Name authorities who cite instances where 
children have been born with teeth. 

A. Pliny, Columbus, Van Swieten, Haller, Marcel- 



48 QUIZ COMPEND 

lus, Dinatus, Baudeloque, Cazeaux, Soemmering, and 
Gardien. 

Q. How many cases did Haller collect? 

A. Nineteen cases. 

Q. What prominent men were born with teeth? 

A. Louis XIV. had two teeth at birth, Bigot, a 
medical philosopher of the sixteenth century, Boyd, 
the poet, Valerian, and some ancient Greeks and 
Romans. 

Q. What other cases are on record? 

A. Polyderus Virgilus describes an infant who was 
born with six teeth. There were two cases typical ot 
foetal dentition shown before the Academie de Mede- 
cine de Paris. One of the subjects had two central 
incisors of the lower jaw, and the other had one tooth 
well through. Levison saw a female born with two 
central incisors in the lower jaw. 



CHAPTER IV, 



POST-NATAL SKULL AND JAW DEVELOPMENT AND 
PERIODS OF STRESS. 

Q. Is the child an immature adult? 

A. No. The child, with its relatively enormous 
head, its large, protuberant abdomen, its small chest, 
short, feeble legs, comparatively vigorous arms, smooth, 
almost hairless skin, large liver,, kidneys, thymus, and 
super-renal capsules, presents a distinct anatomic pic- 
ture from the adult. The child's physiologic and psychic 
life are clear indications in the same direction. 

Q. Do the anthropoid apes resemble man in this 
particular? 

A. Yes. While the young anthropoid is compara- 
tively human, the adult ape is comparatively bestial in 
character. The young ape has a smooth, globular 
head and relatively small face, like man. The profile 
is more human, with little prognathism. The base of 
the skull is more human than in the adult ape. The 
brain is relatively much larger than in the adult. 

Q. What is the case with the gorilla? 

A. The foetus differs from the adult by having 
relatively a much larger head, a longer neck, more 
slender trunk, shorter thumb and great toe, while the 
head is more globular, the face less prognathous, and 
the hand more man-like. In nearly all these characters 
the foetal gorilla approaches man. 

Q. What becomes of the male ape as he grows 
older? 

4 49 



50 QUIZ COMPEXD 

A. The adult male ape rapidly develops into a con- 
dition far removed from his early man-like state. 
Q. What changes take place? 

A. The brain becomes relatively very small, the 
receding skull becomes hideous, with huge bony crests, 
sharp angles, and on its enormously enlarged facial 
portions, prominent, outstanding, superciliary ridges, 
projecting jaws and receding chin, while the dark, 
hairy body becomes more bestial in character. 
Q. How is the female affected? 

A. She remains midway between the infantile and 
the adult male condition. 

O. When do man and the apes most resemble each 
other? 

A. In the infantile stage. 
Q. How do they differ as they mature? 
A. While man, in the course of life, falls away more 
and more from the specifically human type of infancy, 
the ape, in the course of his short life, goes very much 
farther along the road of degradation and premature 
senility. The ape starts in life with a considerable 
human endowment, but in the course of life falls far 
away from it. Man starts in life with a still greater 
portion of human or ultra human endowment, and to 
a less extent falls from it, in adult life approaching 
more and more to the ape. 

Q. From conception till after birth is there a 
greater change in zoologic evolution? 

A. Up to birth, or shortly afterwards, in the higher 
animals, such as the apes and man, there is a rapid 
and vigorous movement along the line upward in 
zoologic evolution. 



ON IRREGULARITIES OF THE TEETH. 51 

Q. Is there a time when this foetal and infantile 
development ceases to be upward? 

A. The time comes when the upward development 
is so directed as to answer to the life wants of the par- 
ticular species. 

Q. What develops later in life? 

A. Throughout life there is chiefly a development 
of lower characters, a slow movement towards degen- 
eration and senility, although one absolutely necessary 
to insure the preservation and stability of the individ- 
ual and species. 

Q. What occurs during foetal life? 

A. Foetal evolution, which takes place sheltered 
from the world, is in an abstractly upward direction. 

Q. What occurs after birth? 

A. After birth further development is a concrete 
adaptation to the environment without regard to 
upward zoologic movement. 

Q. What characteristics of humanity are found in 
the infant? 

A. The human infant presents, in an exaggerated 
form, the chief distinctive characteristics of humanity, 
the large head and brain, the small face, the^ hairless- 
ness, the delicate bony system. 

Q. Which has the best chance in the world, from 
the standpoint of environment? 

A. From the standpoint of adaptation to environ- 
ment the coarse, hairy, large-boned and small brained 
gorilla is better fitted to make his way in the world 
than the delicate offspring; but from a zoologic point 
of view anything but progress occurs. 

Q. Are the first years in man of rapid growth? 

A. From about the third year onward, growth, 



52 QUIZ COMPEND 

though absolutely necessary, adaptation to the environ- 
ment is to some extent growth in degeneration and 
senility. This is not carried to so low a degree as in 
the apes, although by it man is to some extent brought 
nearer to the apes. 

Q. Does the progress toward senility differ in 
different races? 

A. Among the higher human races the progress 
toward senility is less marked than among the lower 
human races. 

O. How does the negro child differ from the 
Caucasic child? 

A. The negro child is scarcely, if at all, less intelli- 
gent than the Caucasic child. 

Q. How do they differ as they grow older? 

A. The negro, as he grows up, however, becomes 
more stupid and obtuse, and his whole social life falls 
into a state of hide-bound routine. 

Q. How does the Caucasic race develop? 

A. It retains much of the child-like vivacity. 

Q. Which types most approximate the child? 

A. The highest human type represented in typical 
man of genius, strikingly approximates to the child 
type. 

Q. What great factors interfere with race develop- 
ment? 

A. The great factors in environment which inter- 
rupt upward race progress are the periods of stress. 

Q. How do the internal actions of the vertebrates 
affect its relations to environment? 

A. Every vertebrate is an aggregate whose 
internal actions are adapted to counterbalance its 
external actions. 



ON IRREGULARITIES OF THE TEETH, 53 

Q. On what does its existence depend? 

A. Preservation of its movable equilibrium, and 
hence existence depends upon its development and 
proper number of these actions. 

Q. How may movable equilibrium be ruined? 

A. When one of these actions is too great or too 
small and through deficiency or need of some organic 
or inorganic cause in its surroundings. 

Q. How can individuals adapt themselves to tnese 
changed influences? 

A. In two ways, either directly or by producing 
new individuals who will take the place of those in 
whom the equilibrium has been destroyed. 

Q. Why? 

A. Since forces exist preservative and destructive 
to the race. 

Q. If these two forces do not counterbalance, how is 
equilibrium established? 

A. Since it is impossible that these two varieties 
of forces should counterbalance, it is necessary that the 
equilibrium should re-establish itself in an orderly way. 

Q. What are these two preservative forces? 

A. The impulse of every individual to self-preser- 
vation, and the impulse to the production of other 
individuals. These must vary in an inverse ratio, and 
the former must diminish when the second increases. 

Q. What does degeneration constitute? 

A. A process of disintegration. 

Q. What term might be applied to all processes 
which complete and sustain life? 

A. Individuation. 

Q. What aids the formation and development of 
new individuals? 



54 QtJIZ COMPEXD 

A. Generation. 

Q. Are these terms necessarily antagonistic? 

A. Yes. 

Q. Do vertebrate embryos at the outset assume a 
common form? 

A. Yes. 

Q. What results from this? 

A. Supernumerary organs and the repetition of 
teratologic types in vertebrates. The higher verte- 
brate embryo contains in essence the organs and poten- 
tialities of all the lower vertebrates. Under the influ- 
ence of heredity or accidental defect an organ or 
structure or function constant in a species may be 
lacking in an individual without the necessity of 
explaining the immediate effects by distant atavism. 

Q. What may varying environment stimulate? 

A. These embryonic potentialities at the expense 
of the later acquired and more typic human organs. 

Q. What is an application of this principle? 

A. The Cohnheim theory of cancer. 

Q. What is the law of economy of growth? 

A. A fixed supply of nutriment, resulting in a 
struggle for existence on the part of the organs and 
structures. While determination by heredity exists 
there are always surrounding forces necessary, not 
simply the condition of activity by an essential ele- 
ment of the final product. There results an internal 
or physiologic struggle for existence between the 
organs, the cells and protoplasmic molecules of the 
organism. 

0. How does this unsimilarity of parts affect 
heredity? 

A. It makes it impossible to establish laws which 



ON IRREGULARITIES OF THE TEETH. 55 

shall govern details of function as to the last cell or 
molecule, since in any army the commander-in-chief 
does not give a special order beforehand affecting 
every private in the ranks. 

Q. Must there be potentiality of adaptation to 
surroundings? 

A. Yes. 

Q. What principle lies back of all development 
of tissues or organs? 

A. Over-compensation of what is used, a quality 
which permits self-regulation and is rarely a necessary 
pre-condition of life. 

Q. What does living matter present? 

A. An external continuity in spite of change of 
condition. 

Q. If the assimilation is not in excess, what hap- 
pens? 

A. If less than consumption, the organism comes 
to an end itself. 

Q. If equal conditions result, what takes place? 

A. Change and nourishment will fail, or injurious 
events will cause destruction. 

Q. How can continuance be assured? 

A. When more is assimilated than is consumed. 

Q. Give an example. 

A. Fire assimilates more than it uses, therefore it 
always has energy left over to kindle new material. 

Q. Do organs assimilate more than they consume? 

A. Yes. But they do not turn all they use to 
assimilation; energy remains over by which the process 
performs something. 

Q. What does this work-product control? . 

A. Excessive assimilation, which otherwise would 



56 QUIZ COMPEND 

come to an end b) r not having sufficient material to 
assimilate. 

Q. What are the more complex processes of life? 

A. A radiation of assimilation, which although not 
identical with combustion is similar to it, the load 
which it carried favoring its continuity. 

Q. How does this radiation load or over-product 
become directed? 

A. By natural selection to keep up a supply of 
food, primarily by moving the assimilating mass. ; 

Q. Is performance of function over and above 
assimilation a condition of continuous assimilation, 
and vice versa? 

A. Yes. 

Q. Is there an inverse relationship between growth 
and product? 

A. Yes. 

Q. Of what does the course of development con- 
sist? 

A. In properly directing the work-products. 

Q. What does this represent so far? 

A. Merely a continuous productibility of function 
in connection with assimilation. 

O. A productibility which is stored up and dis- 
charged bv an outer stimulus of environment will 
produce what? 

A. It will be more economic, and give rise to what 
is known as reflex excitability. 

Q. What happens when this reflex product domi- 
nates according to circumstances? 

A. Function will sometimes be greater or less. 

Q. What will happen under these conditions if 
assimilation continues? 



ON IRREGULARITIES OF THE TEETH. 57 

A. There must sometimes be an overplus, some- 
times a balance, and sometimes an excessive function, 
death, and their elimination. 

Q. What must be done to avoid this last? 

A. It is necessary that assimilation should depend 
upon use or upon stimulus which use calls forth. 

Q. From the psychic side, stimulus is recognized 
as what? 

A. Hunger. 

Q. What is this kind of process where stimulus is 
an indispensable factor? 

A. It is more special and limited than the more 
general process of assimilation plus movement, etc., 
but has characteristics which favor it greatly in the 
struggle for existence. 

Q. How is the greatest saving of material ob- 
tained? 

A. By the most complete self-regulation of function- 
ation. 

Q. What becomes of the parts that are used? 

A. They are strengthened and grow. 

Q. What becomes of the parts that are unused? 

A. They degenerate and the material for their sus- 
tenance is saved? 

Q. How does the union of the greatest economy 
with the highest functioning of the whole affect the 
parts? 

A. At the cost of the independence of the parts. 

Q. What is the result of differentiation? 

A. Senescence, in which the parts exist merely 
on account of the function which they perform for 
the whole. 

Q. What fact allows a fresh start in development? 



58 QUIZ COMPEND 

A. The senescing organ withers and may even 
descend in this condition from generation to genera- 
tion. 

Q. What is the progress of the organism during life? 

A. The organism moves from a more general, 
more easily impressible, condition to one more per- 
fectly mechanized. Through a long period it becomes, 
through the continuous working of a given stimulus, 
more completely adapted to itself and also more differ- 
entiated, and thereby more stable, so that an always 
increasing opposition is formed to the additional 
development of new forms and characteristics. 

Q. Does the law of economy of growth hold good? 

A. Not only as an organic unit but as a compound 
organism even as a social unit. 

Q. What is degeneracy? 

A. Degeneracy is a gradual change of structure 
by which the organism becomes adapted to less varied 
and complex conditions of life. 

Q. What is elaboration? 

A. It is a gradual change of structure by which 
the organism becomes adapted to more varied and 
complex conditions of existence. 

Q. What occurs in elaboration? 

A. There is a new condition of form corresponding 
to new perfection of work in the animal mechanism. 

Q. What, in degeneracy? 

A. In degeneracy there is a suppression of form 
corresponding to the cessation of work. 

Q. Are elaboration and degeneracy ever found in 
one individual? 

A. Elaboration of some one organ may be a nec- 
essary accompaniment of degeneracy in all the others. 



ON IRREGULARITIES OF THE TEETH. 59 

Q. Does this often occur? 

A. It is very generally the case. 

Q. When can the individual be regarded as an 
instance of degeneracy? 

A. Only when the total results of the elaboration 
of some organ and the degeneracy of others is such 
as to leave the whole mass in a lower condition, that 
is fitted to less complex action and reaction to its sur- 
roundings than is the type. 

Q. Since degeneracy is a process of evolution, lead- 
ing to alteration of form because of cessation of inhi- 
bition in certain directions resultant on diminished 
work, what follows? 

A. Since diminishing functionating precedes 
change of structure, increased functionating must 
check the change of structure in its biologic 
stage. 

Q. Why do the degenerate races sometimes rise 
higher in evolution? 

A. Because of the utilization of the beneficial 
varieties due to degeneracy. 

Q. Why is the influence of this principle increased? 

A. Because the majority of children of degenerates 
inherit a tendency to degeneracy rather than degen- 
eracy itself. 

Q. Can structural elaboration due to degeneracy 
be retained? 

A. It is evident that structural elaboration due to 
degeneracy may be retained while the degenerate 
structures resume their higher functions. 

Q. Upon what do intra-uterine periods of stress 
depend? 

A. Since certain parts disappear in the evolution 



60 QUIZ COMPEND 

of organs, and certain organs during the evolution of 
organisms, and since the disappearance and develop- 
ing tendency must center around the time when cer- 
tain functions will be lost by the disappearing and 
others gained by the developing, periods of stress must 
occur, around which the law of economy of growth 
will center, the struggle for existence between the 
parts of organs and between the organs. 

Q. When are the struggles for existence on the 
part of the different organs and systems of the body 
most intense? 

A. During the periods of intra- and extra-uterine 
evolution and involution. 

Q. When are these periods? 

A. During the first dentition, during the second 
dentition (often as late as the thirteenth year), during 
puberty and adolescence (fourteenth to twenty fifth), 
during the climacteric (fortieth to sixtieth), when 
uterine involution occurs in women and prostatic 
involution in man, and finally, during senility 
(sixtieth and upwards), mental or physical defects may 
occur, a congenital tendency to which has remained 
latent until the period of stress. 

Q. When systematic balance, the result of evolution t 
is disturbed by change in environment, what takes 
place? 

A. The organs do not pursue their usual 
growth. 

Q When are such disturbances apt to occur? 

A. They are peculiarly liable to occur during 
periods of stress, because of the then varying relation 
of the different organs. 

Q What is the weight of the brain during the first 



ON IRREGULARITIES DF THE TEETH. 61 

extra-uterine period of stress between birth and three 
months? 

A. It is one-fifth the weight of the body, while in 
the adult it is but one thirty-third. 

Q. How does the brain grow during the first six 
months? 

A. It doubles in weight. 

Q. What would be the effect of stress during this 
period? 

A. Under the law of economy of growth, it would 
either be felt in diminution of quality or quantity of 
the brain or the preservation of these at the expense 
of more transitory structures. 

Q. What structure would be likely to become 
involved? 

A. The jaws, alveolar process, and teeth. 

Q. During the period between two years and six, 
what would take place? 

A. The same factors, to a lessened degree, are 
present, while between seven and fourteen the brain 
has quadrupled in weight. 

Q. What is the size of the heart at birth? 

A. It is small, relatively to the arterial system, but 
this disproportion gradually disappears until at 
puberty, when the relation is changed. 

Q. What advantages has a heart relatively larger 
in regard to the blood vessels? 

A. The higher the blood pressure, the earlier, 
stronger and more complex the development of 
puberty. 

Q. What is the weight of the heart from birth on- 
wards? 

A. It increases twelve and one-half times. 



62 QUIZ COMPEND 

Q. What occurs from strain during this period? 

A. Strain interfering with heart growth would 
either affect it,or under the law of economy of growth 
the more transitory structures for its benefit. 

Q. What do periods of stress resemble? 

A. To a certain extent periods of stress resemble 
ancestral states. 

Q. Do these periods summarize ancestral progress? 

A. Yes. Evolution may take place without leaving 
traces of the various stages. 

Q. Where is this most noticeable? 

A. In complex organs which have been produced 
by many lines of evolution converging in a single 
structure; a structure which thus becomes the seat 
of a special function or set of functions. 

Q. Give an example. 

A. The neuron, for instance, the nerve-cell unit of 
the human brain cortex, passes successively through 
stages corresponding to those which are to be found 
in adult fish, frog, bird, and mammal. 

Q. Wherein does development appear? 

A. In an increasing complexity of the cell, with no 
formation of unnecessary rudimentary parts. 

O. Does this appear in man? 

A. Yes. When the human brain development is 
compared with the probable ancestral stages evident 
in the vertebrate series. 



CHAPTER V. 



DEVELOPMENT OF THE CRANIUM AND FACE. 

Q. How is the human skull developed? 

A. It has a double origin. There are really two 
skulls, one inside of the other. 

Q. Were these originally distinct? 

A. Yes, but in the process of evolution the union 
between them became more and more intimate. 

Q. Wherein is this development evident? 

A. In the changes which embryologically occur in 
man. 

Q. What is the primary skull? 

A. It is practically an extension of the vertebrae, 
which send out side growths to cover the brain, as the 
backbone covers the spinal cord. 

Q. Describe this process. 

A. The primary skull extends in front of the 
notochord (the spinal cord of the human embryo and 
the permanent spinal cord of the lancelet), where it 
gives off two trabeculae cranii (front skull plates). 
Behind it, the primary skull or chondrocranium gives 
off two occipital or rear skull plates. It also gives off 
two plates (midway between the trabeculae and occi- 
pitals), which, as they gradually enclose the primitive 
hearing apparatus (the otocysts, permanent in fish and 
embryonic in man) are called periotic capsules. 

Q. What is the nature of this primary skull? 

A. It is at first cartilaginous, as in sharks. 

Q. What occurs in consequence of increase in the 

63 



64 QUIZ COMPEND 

size of the brain in evolution and in human embry- 
ology? 

A. This cartilaginous primary skull becomes insuf- 
ficient to roof over the brain, and thus are produced 
the gaps called fontanels, which are the result of 
failure of the chondrocranium (primary skull), to 
cover the gains of the nervous system in the struggle 
for existence. 

Q. How is this deficiency overcome? 

A. The skin of the mammal retained a bone 
making function inherited from the reptiles and bony 
fishes. 

Q. How were these cavities filled? 

A. With dermal bones, which, at first serving 
merely as armour in the skin of the head, came ulti- 
mately to be protectors of the nervous system. 

Q. What bones represent the dermal bones in the 
embryonic human skull? 

A. The frontals, whose sutures normally disappear 
in the adult, so that the forehead seems to be but one 
bone. This union may not occur when, as in the case 
of the philosopher Kant, the frontal suture remains 
during life. The sutures are replaced by solid bone 
through synostosis. In the frontal bone, synostosis is 
normal, and in the line of advance. Elsewhere in the 
skull it is often an expression of a premature senility 
that may give rise to various cranial states either 
absolutely degenerate in type or degenerate only when 
present in certain races. The parietals and inter- 
parietals are dermal bones so united by synostosis as 
to form the parietals or side bones of the normal adult 
skull. 

Q. What other bones of the head are dermal bones ? 



ON IRREGULARITIES OF THE TEETH, 65 

A. The nasal bones, which, together with the 
vomer, form the nose, are likewise dermal bones, and 
so are the pterygoids and palatines. The maxillaries 
and praemaxillaries, which (with the mandibles) form 
the jaws, are dermal bones. The mandibles are in 
part derived from the chondrocranium. 

Q. What becomes of the mouth cavity in the head 
bend of the embryo? 

A. It is brought between the forehead and the 
heart and upon the ventral surface. 

Q. Upon what does the development of the face 
depend? 

A. The enlargement and fusion of the mouth and 
nose cavities, and upon the later partial separation of 
the nose and mouth and nose cavities, leaving the 
posterior nose open. 

Q. On what does it depend further? 

A. The growth and specialization of the face 
region, of which elongation is the most prominent 
indication, and finally upon, the development of a 
prominent external nose. 

Q. What takes place when the medullary tube of 
the notochord enlarges to form the brain? 

A. The head bends over to make room for that 
enlargement. 

Q. What becomes of the mouth plate in the bend- 
ing of the head? 

A. The mouth plate, which is to be the mouth, is 
carried over to the front of the head] 

Q. What changes take place in the development of 
the mouth cavity? 

A. The growth of the brain and increase in size of 



66 QUIZ COMPEND 

the heart cavity, which expands in front, leaving the 
mouth cavity between them. 

Q. What does the mouth cavity represent? 

A. Two gill-slits united in the front line. 

Q. How is the nose formed? 

A. The nose is formed from two olfactory plates, 
situated just in front of the mouth, and in contact 
with the fore brain. 

Q. How do these olfactory plates grow? 

A. They grow in size by the increase of tissue, 
and the resulting pits pass away from the brain. 

Q. With what do these pits communicate? 

A. Freely with the mouth. 

Q. What do the nasal processes include? 

A. The origin of the future nose and the future 
intermaxillary region of the upper lip. 

Q. How are the nasal pits developed? 

A. By the upgrowth of the ectoderm and meso- 
derm and the olfactory plate. 

Q. Where does the upgrowth take place? 

A. On the medial, upper and lateral side of each 
plate, and hence forms two pits with a partition (the 
future nasal septum) between them. 
• Q. How do the nasal pits communicate? 

A. Along their whole lower side, directly with the 
mouth cavity. The nasal pit is at first very shallow. 

Q. How many changes are there during their 
growth? 

A. Two. First, growth of the tissue occurs around 
the olfactory plate, and then the pits migrate away 
from the brain. 

Q. How are the nasal pits separated? 

A. By a projecting mass of tissue, called the nasal 



ON IRREGULARITIES OF THE TEETH. 67 

process, which includes the partition between the two 
nasal chambers in outline of the future nose and of 
the future intermaxillary region of the upper lip. 

Q. Where does the maxillary process extend? 

A. Between the mouth and eye, toward the nasal 
pit, and by joining the rounded end of the nasal pro- 
cess, begins the separation of the nasal and buccal 
chambers and completes the upper border of the 
mouth. 

Q. What takes place as development proceeds? 

A. The lateral ridge grows forward and covers in 
the nasal pit from the sides, forming the outline of 
the wing of the adult nose. There are now two 
external nares. 

Q. Do the nasal chambers enlarge? 

A. They enlarge as the whole face enlarges, and 
occupy an increasing space, opening widely into the 
mouth cavity above the palate split. 

Q. From what is the so-called labyrinth of the 
nose formed.? 

A. From the nasal pits proper. 

Q. When doe's it begin to develop? 

A. It begins with the appearance (third month of 
embryonic life) of three projecting folds on the lateral 
wall of each nasal chamber. 

Q. What are they called? 

A. Upper, middle, and lower turbinal folds. They 
very early contain cartilage. 

Q. How does the formation of the labyrinth 
advance? 

A. By the formation of the outgrowths, which 
become the ethmoidal sinuses by the appearance, dur- 
ing the sixth month, of the antrum of Highmorii, or 



68 QUIZ COMPEND 

expansion of the nasal cavity into the region of the 
superior maxillary, and finally by evaginations to 
form the sphenoidal and frontal sinuses, which, how- 
ever, do not arise in man until after birth. The sepa- 
ration of the olfactory plate from the brain does not 
take place until the olfactory ganglion develops from 
the epithelium. 

Q When does the separation of the olfactory plates 
from the brain take place? 

A. Not until the olfactory ganglion develops from 
tfre epitnelium. The fibers lengthen, the olfactory 
and neural epithelium separate and finally osseous 
cribriform plate is developed between them. 

Q. When does the external nose develop? 

A. Toward the end of the second month of embry- 
onic life by a growth of the nasal process. 

Q. What is the shape of the external nose at the 
third month of embryonic life? 

A. It is at first short and broad, having very nearly 
the shape which is permanent in certain negro races. 
Later the external nares and wings of the nose are 
carried forward with a general nasal upgrowth. 

Q. What takes place as soon as the external nose 
is separated from the mouth? 

A. There is a partition between the nasal pits and 
the mouth. 

Q. How is the upper part of the mouth covering 
formed? 

A. The partition in which the intermaxillary bone 
is differentiated later, is supplemented by another par- 
tition, the true palate, which shuts off the upper part 
of the mouth cavity from the lower, thus adding the 
upper part of the nose chambers. 



ON IRREGULARI1IES OF THE TEETH. 69 

Q. What is the palate? 

A. It is a secondary structure, which divides the 
mouth into an upper respiratory passage and a lower 
lingual or digestive. 

Q. How is the palate developed? 

A. The palate arises as two shelf-like growths of 
the inner side of each maxillary process and is com- 
pleted by union of the two shelves in the median line. 

Q. How are these arched? 

A. So as to descend a certain distance into the 
pharynx. 

Q. Are these growths arrested? 

A. Yes, though they may be still recognized in the 
adult. 

Q. Where do the palate shelves continue growing? 

A. In the region of the tongue, which, rising 
between them, seems in sections which pass through 
the internal nares, to be about to join the internasal 
septum. 

Q. What becomes of the tongue as the lower jaw 
grows? 

A. The floor of the mouth is lowered, and the 
tongue is thus brought further away from the inter- 
nasal septum. 

Q. What becomes of the palate shelves.? 

A. They take a more horizontal position and pass 
toward one another, above the tongue, and below the 
nasal septum to meet in the middle line, where they 
unite. 

Q. How do the shelves unite? 

A. From their original position, the shelves nec- 
essarily meet in front toward the lip first, and unite 
behind toward the pharynx later. 



70 QUIZ COMPEND 

Q. What time do they unite in the human embryo? 

A. Union begins at the eighth week, and is com- 
pleted by the ninth for the hard palate, and by eleven 
weeks for the soft. 

Q. Where do the palate shelves extend? 

A. Back across the second and third brachial arches. 

Q What time does the uvula appear? 

A. During the latter half of the third month, as a 
projection of the border of the soft palate. 

Q. When does the nasal septum unite with the 
palate? 

A. Soon after the palate shelves have united with 
one another, the nasal septum unites with the palate 
also, and thereby the permanent or adult relation of 
the cavities are established. 

Q. What value is degeneracy of the face? 

A. The fact that the human face is modified back- 
ward from the vertebrate type excellently illustrate^ 
the degeneracy of a series of related structures for the 
benefit of the organism as a whole. 

Q. Why is the process of development of the ver- 
tebrate face checked in man? 

A. Because the upright position renders it unnec- 
essary to bend the head, as in quadrupeds, and because 
the enormous cerebral development has rendered an 
enlargement of the brain cavity necessary. 

Q. How has this taken place? 

A. By extending the brain cavity over the nose 
region as well as by enlarging the whole skull. 
Because development of the face is arrested at an 
embryonic stage. The production of a long snout is 
really an advance of development, which does not 
occur in man. 



ON IRREGULARITIES OF THE TEETH. 71 

Q. What depends upon the variations of the dermal 
bones? ■■" 

A. Not only the race variations in skull and jaw 
types, but also the variations produced by agencies 
acting on the individual during the periods of bodily 
stress and by the degenerative influences. 

Q. What do craniologists generally assume? 

A. Two fundamental skull types, dolichocephaious, 
or long-headed, and brachycephalous, x or round- 
headed. 

Q. How are these types determined? 

A. By the so-called cephalic index, which is deter- 
mined by the relation of the antero-posterior diameter 
(measured from the glabella to the farthest point of 
the occiput) to the transverse diameter from side to 
side. The former being taken at ioo, the latter will 
range from about 60 to 95, or even more, increasing 
with the greater degree of brachycephaly and vice 
versa. 

Q. What are the extremes, excluding artificial 
deformities? 

A. Excluding artificial deformation, the extremes 
appear to lie letween 61.9 (Fijian, measured by 
Flower) and 98.21 (a Mongolian, described by Huxley). 
This last approaches the perfect circle, which is never 
presented by the normal head, though exceeded 
(103-105) by pathologic, teratologic or deformed 
specimens. 

Q. What are most people now? 

A. Most people are now mesaticephalouB and hence 
of mixed descent. 

Q. When did race intermingling begin? 

A. In the neolithic period. ; ; 

6 



72 OUIZ qOMPEND 

Q. Is the horizontal index greater or less than it 
was? 

A. It is considerably less in the primary than in the 
secondary divisions of mankind. 

Q. Are there exceptions? 

A. The alleged normal dolichocephaly of African 
negroes has numerous exceptions. The Eskimo, who 
seemingly ought to be brachycephalic, are extremely 
dolichocephalic. 

Q. To meet the endless transitions between the 
two extremes, what table did Broca devise? 

A. i. Dolichocephali, with index No. 75 and under. 

2. Sub-dolichocephali, with index No. 75.10 to 

77.77. 

3. Mesaticephali, with index No. 77.78 to 80. 

4. Sub-brachycephali, with index No. 80. 10 to 

S3- ^ 

5. Brachycephaii, with index No. 83.34 up- 

wards. 

Q. What cranial measurement is of great import- 
ance to the dentist? 

A. That which determines the varying gnathism 
or greater or less projection of the upper jaw, which 
depends upon the angle made by the whole face with 
the brain cap. 

Q. How is this applied? 

A. The more obtuse the angle the greater will be 
the maxillary projection (prognathism), the more ver- 
tical the face the less the projection (orthognathism) ; 
hence gnathism (best seen in profile), as indicated by 
the facial angle, is accepted by anthropologists as a 
race criterion. 



ON IRREGULARITIES OF THE TEETH. 73 

Q. What has been the effect of evolution upon the 
face? 

A. The evolution (intimately associated with the 
dentition and change from raw to cooked food) has 
been from the extreme projection of the higher apes 
and of primitive man to the seemingly vertical posi- 
tion of the Mongolic and Cau casic groups. 

Q. What does prognathism and orthognathism 
indicate? 

A. Prognathism is hence characteristic of the lower 
and orthognathism of the higher races. 

Q. Give an illustration. 

A. The profile of the Calmuck face is almost ver- 
tical, the facial bones being thrown downwards and 
under the forepart of the skull. The profile of the 
face of the negro is differently inclined; the front part 
of the jaws projecting far forward beyond the level 
of the fore part of the skull. In the former the skull 
is orthognatous, or straight-jawed, in the latter it is 
prognathous. 

Q. What other features have been added? 

A. Combining this feature with eurygnathism (that 
is, lateral projection of the cheek bones) the Caucasic 
face is oval with vertical jaws, the Mongolic broad 
(eurygnathous), the negro prognathous, and the Hot- 
tentot, both pro and eurygnathous. 

Q. How does Topinard distinguish between a 
superior and anterior angle? 

A. The former (general facial gnathism) is falla- 
cious as a guide ; the latter (that is, sub-nasal gnath- 
ism,) being trustworthy. 

O. How have anthropologists erred? 

A. By giving so much importance to the projec- 



74 QUIZ COMPEND 

tion of the whole maxilla, or the whole face. There 
is no uniformity of results in a given case. The most 
flagrant contradiction occurs between averages^ in 
allied races. 

Q. What is the best method of measurements? 

A. The sub-nasal, or true prognathism, furnishes 
the differential character of the various human types. 

Q. How are these determined? 

A. By the angle formed by a line drawn from 
the nasal spine (sub-nasal point) to the anterior 
extremity of the alveolo-condylean plane. 

Q. What does this plane give? 

A. The total projection of the skull is about par- 
allel with the horizontal line of vision, coinciding with 
a line drawn from the alveolar point (medium point of 
the alveolar arch) at right angles to a perpendicular 
line falling from the occipital condyles. 

O. Give a few illustrations? 

A. Individual extremes, 89 to 51.3. 
White races, 82 to 76.5. 
Yellow races, 76 to 69.5. 
Black races, 69 to 59.5. 

O. What does this indicate? 

A. From this it is evident that absolute orthogna- 
thism does not exist. 

Q. What is the gnathism of most of the races? 

A. All are more or less prognathous, the European 
least, the negro most, the Mongol and Polynesian 
intermediate. In Europe the most orthognathous 
were the Gauls, Corsicans and Neolithic men. The 
Finns were the least. 

Q. What does orthognathism mean in anthro- 
pology? 



ON IRREGULARITIES OF THE TEETH. 75 

A. As the term is used in anthropology, it simply 
applies to the sub-nasal type. 

Q. What other factors in dentistry must be taken 
into account? 

A. The relation of the inferior maxilla must like- 
wise be taken into consideration, since around this 
. turns the struggle for existence between the jaws and 
teeth. 



CHAPTER VI. 



DEVELOPMENT OF THE JAWS. 

Q. Where does the vertebrate mouth belong in the 
primitive stage? 

A. On the under side of the head. 

Q. How do constitutional disorders and infectious 
diseases influence growth and development of the 
maxillaries? 

A. The hypophysis, or pituitary body, has much 
to do with the osseous development of the body. If it 
be affected, anomalies result. 

Q. How does this affect the jaws? 

A. Since the face, including the jaws, are trans- 
itory structures, changed glandular action may pro- 
duce either excessive or arrest of development. 

Q. To determine jaw width, where are measure- 
ments taken? 

A. From the outer surface of one first permanent 
molar to the outer surface of the other. 

Q. Why at that locality? 

A. Because the first permanent molar erupts at the 
sixth year. It is developed independently of the other 
teeth. It is a fixture in the jaw, and it gives the most 
accurate width, being situated midway from before, 
backward. 

Q When are the best results obtainable? 

A. Between twenty-five and thirty-five. 

Q. Why? 

11 



78 QUIZ COMPEND 

A. Because the jaws, like the rest of the body, 
continue to grow until that period. 

Q. Why is such a .wide distinction made in the 
ages? 

A. A normal, healthy individual usually obtains 
his growth at twenty-five. A neurotic or degenerate 
may not obtain his growth until thirty-five. 

Q. What instrument is used to obtain these 
measurements? 

A. The ordinary mechanical callipers. 

Q. Do jaws differ in size in different races and 
peoples? 

A. Yes. 

Q. Why? 

A. All things considered, the size of the jaws 
correspond with the size of the bony framework. 
This, however, only holds true so far as the primitive 
races are concerned. 

Q. How about modern and mixed races? 

A. Owing to inheritance, to disease, to climate, 
soil, and environment changes, excessive and arrested 
development occurs, modifying the size of the jaws. 

Q. Give examples. 

A. The jaws of the European races are larger than 
those of the European-American. The jaws of the 
American Indian are larger than those of the English 
or American. The jaws of peoples living in the older 
parts of the American Continent are smaller than in 
the newer parts. 

Q. Of what does the antero-posterior diameter con- 
sist? 

A. The distance at the median line from a line 
drawn across from the posterior surface of the last 



ON IRREGULARITIES OF THE TEETH 79 

molars to the anterior alveolar process between the 
central incisors. 

Q. How do the jaws of the female compare in size 
with those of the male? 

A. Those of the female are smaller. 

Q. How is room secured for the eruption of the 
second and third molars? 

A. The development of the jaws is from before, 
backward. 

Q. What effect has human evolution upon the jaws 
and face? 

A. It arrests development. The jaws are growing 
shorter. 

Q'. Under what circumstances does marked arrest 
take place? 

A. In cases where there is an unstable nervous 
system. It also frequently occurs from exanthema- 
tous diseases. 

Q. What local condition will arrest jaw develop- 
ment? 

A. Premature extraction of the first permanent 
molars. 

Q. What effect does this have upon the jaws? 

A. The jaws shortening naturally from an evolu- 
tionary standpoint, and developing backwards suffi- 
ciently merely to receive the second and third molars, the 
removal of the first permanent molar allows the second 
and third (should there be one) to move forward. 

Q. What other local conditions will arrest jaw 
development? 

A. When the child inherits small teeth from one or 
the other parent, or when the child, owing to disease, 
develops teeth smaller than normal. 



80 QUIZ COMPEND 

Q. Under what conditions do the jaws differ in 
normal individuals? 

A. Two types of jaws are observed: in brachyceph- 
alic the broad, square jaws; in dolichocephalic, the 
long, narrow jaws. 

Q. Do these comparisons always exist? 

A. No. Only in relatively pure races. 

Q. Why not? 

A. Because the tendency of both extremes is 
towards the mesocephaly. Should a long-headed per- 
son marry a round-headed individual, the offspring 
might have a round head and long jaws, another a 
long head and a square jaw. 

Q. What is the law of economy of growth? 

A. It is that law whereby an organ or structure 
is sacrificed for the benefit of the organism as a 
whole. 

Q. Give illustrations. 

A. The vermiform appendix was much larger and 
longer in lower mammals. It was used to assist veg- 
etable digestion. Now it is not required, and is dis- 
appearing. The muscles of the ear are largely devel- 
oped in the lower animals to move the ear in different 
directions. In man they are not required. The jaws 
and teeth in early races were used for grinding foods. 
Now food is cooked soft. Large teeth and jaws, with 
powerful muscles, are not required. In these cases 
and many others under this law, unnecessary organs 
and structures are disappearing. 

Q. Do the jaws of peoples whose ancestors have 
long lived in a given environment differ in size? 

A. They do not. 

Q. Why? 



ON IRREGULARITIES OF THE TEETH. 81 

A. Because they are reduced almost to their lowest 
size without causing deformity. 

Q. What difference exists between jaws of ancient 
Britons and Romans and those of modern English and 
Italians? 

A. There is from .24 to . 36 of an inch difference. 

Q. How do the New England jaws differ from 
English? 

A. The English jaw is relatively smaller. 

Q. How is development harmonizing the long 
diameter of the teeth with the size of the jaw? 

A. By reducing the size of teeth or causing their 
disappearance. 

Q. In primitive races is the third molar well devel- 
oped? 

A. It is. It also has ample room. 

Q. How is the alveolar process assisted in develop- 
ment? 

A. When all the teeth are in the jaw, they wedge 
the alveolar process outwards, thus expanding it. 

Q. Is the third molar larger or smaller in the 
Orang, or Chimpanzee, than in man? 

A. Larger. 

Q. How is it in man? 

A. The reverse. The first molar is largest, and 
they decrease in size from before, backwards. 

Q. Is the loss of teeth often in harmony with 
arrested jaw development? 

A. It is not. 

Q. What is one of the great causes of arrested jaw 
development? 

A. Disuse, which prevents blood from being carried 
to the parts for nourishment. 



82 QUIZ COMPEND 

Q. How do the two jaws differ in this respect? 

A. The upper jaw is more frequently arrested, 
owing to the fact that it is a fixed bone. 

Q. Under what circumstances are the jaws liable 
to become excessively developed? 

A. In neurotics and degenerates the nervous sys- 
tem is unstable, thus carrying more than the usual 
amount of nourishment to the parts. 

Q. Which jaw is the most liable to become exces- 
sively developed? 

A. The inferior maxilla, because it is mobile. 

Q. When the inferior maxilla is developed in 
excess of the superior, what mistake is sometimes 
made by the dentist? 

A. It is supposed that the patient has "jumped the 
bite. ' 

Q. Are teeth more liable to decay upon the upper 
jaw than upon the lower? 

A. Yes. 

Q. Why? 

A. Because the upper is degenerating faster than 
the lower. 

O. Is degeneracy (or arrest of development) of the 
jaws and teeth a cause of decay? 

A. Yes. It is the principal cause. In the evolu- 
tion of tooth structure, the closing of the apical end 
of the root, the malformation of tooth structure cuts 
off nourishment, and with the lost art of mastication, 
tends to produce malnutrition. 

Q. How do these conditions mentioned hasten 
decay? 

A. Defective enamel and low vitality allow lactic 
acid ferments an easy prey upon tooth structure. 



ON IRREGULARITIES OF THE TEETH. 83 

Q r Do constitutional conditions produce marked 
effect upon the teeth? 

A. They do. Syphilis, tuberculosis, pregnancy, 
Bright's disease, and all diseases with disturbances in 
nutrition, as well as senility, predispose to tooth decay. 

Q. If evolution of the jaws and teeth be underlying 
cause of tooth decay, then do marked differences result 
in decay of individual teeth? 

A. Yes. Because of the fixedness of the upper 
jaw 7 and its proneness to degeneracy, these teeth are 
more susceptible to decay, according to Magitot, in the 
proportion of 3.2, according to Hitchcock 1.9, or very 
nearly two to one. 

Q. How about the teeth on each jaw? 

A. The molars are more liable to decay than the 
bicuspids, the bicuspids than the cuspids or incisors. 
The evolution of the jaws and the lost art of mastica- 
tion directly affect the molars or grinding teeth first. 

Q. Is it true that if a tooth remain in the jaw 
before it erupt, the longer will the individual have it, 
and the stronger will the tooth become? 

A. This is but partially true. Thus degenerate 
conditions and loss of the third molars are along the 
line of evolution. Owing to its degeneration, its 
vitality is reduced, and it almost always decays early. 
Its power of resistance depends much upon its shape 
and number of roots, meaning blood supply. 

Q. Does the mechanical arrangement in the erup- 
tion of the teeth and the movement of the jaw assist 
in enlargement? 

A. It does. Thus want of mastication, as in idiots, 
may cause arrest of development and irregularities of 
the teeth. 



CHAPTER VII. 



DEVELOPMENT OF THE ALVEOLAR PROCESS. 

Q. What is the alveolar process? 

A. It is the part of the jaw bone that contains the 
teeth. . 

Q. Where is it located? 

A, Upon the upper border of the inferior maxilla 
and upon the lower border of the superior maxilla. 

Q. How does it differ from the jaw bone proper? 

A. The jaws proper are composed of dense, hard 
bone structure, which remain throughout life for the 
purpose of attachment of muscles, while the alveolar 
process is made up of cancellated bone structure, 
which comes and goes with the teeth. 

Q, When does it first make its appearance? 

A. When the first teeth erupt. 

Q„ What becomes of it when the first teeth are 
shed? 

A. It absorbs away. 

Q. When does it reappear? 

A. When the permanent teeth erupt. 

Q. Does the process always follow the teeth? 

A. Yes. No matter how irregularly they may 
erupt, the process builds itself about the roots of 
the teeth. 

Q. Do alveolar processes differ in length and 
width? 

A. Yes. The length of the alveolar process 
depends upon the length of the roots of the teeth, and 

85 



86 QUIZ COMPEND 

the length of the rami. The teeth continue to erupt 
until they reach occlusion. The width also depends 
upon the length of the rami ; if short, the alveolar 
process is short and thick. 

Q. What causes some small vaults to be high and 
others low? 

A. The length of the alveolar process. 

Q. Is the process between the teeth growing 
thinner? 

A. It is. This is due to the change in the shape 
of the crowns of the teeth. Once they were bell- 
shaped, now they are almost straight, thus lessening 
the width of the septum. 

Q. Of what is the alveolar process composed? 

A. The alveolar process is composed of a fibrous 
mesh, filled with lime salts, loosely put together. 
When treated with acids, the lime salts are destroyed. 
When treated with heat, the fibrous tissue is removed. 
In both cases the shape of the structure is retained.- 

Q. How are the teeth held in position? 

A. By a process called gomphosis, which resembles 
the attachment of a nail in a board, by their exact 
adaptation to the tissue. When bent or irregular, they 
receive support from all sides, and by the peridental 
membrane. 

Q. Does absorption of the alveolar process occur 
when the teeth are in position? 

A. Yes. Sensile absorption, or osteomalacia, may 
occur at any period after the person has obtained his 
growth. Should man live long enough, he would lose 
his second set of teeth normally. 

Q. What becomes of the alveolar process after the 
second set of teeth are removed? 



ON IRREGULARITIES OF THE TEETH. 87 

A. The process absorbs entirely away. 

Q. When the dental arch expands, does the alveolar 
process move? 

A. Yes, to a certain extent. When teeth are reg- 
ulated, the process will move and build about them to 
a limited extent. 

Q. Does the alveolar process vary in position? 

A. Very materially. The eruption of the teeth is 
purely mechanical, depending upon the number and 
size of the jaw bone and manner of eruption. The 
position and shape, therefore, depends entirely upon 
the shape assumed by the teeth. 

Q. Will the alveolar process develop if the teeth 
are not present? 

A. It will not. 

Q. Is there excessive and arrested development of 
the alveolar process? 

A. It is very common. Owing to the transitory 
nature of this structure, it is easily affected by nutri- 
tion changes. A normal development is noticed when 
one or more teeth do not antagonize with those on 
the opposite jaw. The alveolar process will lengthen 
until they meet resistance. Arrest of development 
is noticed in cases of rickets, hydrocephalous, anaemia, 
syphilis, tuberculosis, etc. 

Q. Is excessive development frequently observed 
in degenerates? 

A. Yes. Owing to the unstable nature of the 
nervous system, the alveolar process is easily 
affected. 

Q. When is hypertrophy found? 

A. It is very common among neurotics and degen- 
erates. It may affect only one tooth, such as the third 



88 QUIZ COMPEND 

molar, or one side of the mouth, or the entire alveolar 
process may become involved. 

Q. How does the alveolar process appear under 
the microscope? 

A. Not unlike bone. It contains Haversian canals 
of two kinds, one with the regular lamellae system 
surrounding it, the other the small vessels of Von 
Ebner, which have no surrounding lamellae. 

Q. Describe them. 

A. The Haversian canals are large, round, smooth 
spaces, containing a single artery. The dark spots 
circling each are the lacunae. The thread-like spaces 
are canaliculi, which run from one lacuna to another, 
and from one Haversian canal to a lacuna. The 
spaces between are filled with lime salts. The vessels 
of Von Ebner are little blood vessels, running in' all 
directions and penetrating the layer of bone. They 
are for the purpose of nourishing the bone structure. 



CHAPTER VIII. 



DEVELOPMENT OF THE VAULT. 

Q. What names has the roof of the month? 

A. The arch, the dome, the palate, the vault. 

Q. Which is the most common? 

A. The arch. 

Q. Why should this term not be used? 

A. Because it conflicts with the use of the estab- 
lished term, dental arch. When speaking of a V, or 
saddle arch, the dental and not the roof of the mouth 
is meant. 

Q. What are better terms? 

A. The vault, or palate. 

Q. What constitutes the vault? 

A. The vault is composed of the hard and soft 
palate and the alveolar process. 

Q. Of what does the hard palate consist? 

A. The hard palate consists of two horizontal 
plates of bone extending from the superior maxillary 
bones upon either side, and uniting at the median line, 
and from the anterior alveolar process in front, it 
extends back and unites with the soft palate. 

Q. What bones constitute the vault? 

A. It is composed of two incisive bones, two palate 
plates of the superior maxilla and two horizontal plates 
of the palate bones. 

Q. At what period does ossification of the median 
suture occur? 

A. It varies in different individuals, sometimes as 

89 



90 QUIZ COMPEND 

early as the third and fourth years, and in neurotics 
and degenerates as late as the fifteenth and sixteenth 
years. 

Q. How can this wide difference in years be deter- 
mined? 

A. In widening the arch by the jack-screw, or other 
means. It is not uncommon to open the suture in 
children from fourteen to sixteen years of age. 

Q. Is this detrimental to the operation? 

A. No. It is of great advantage. It produces 
greater harmony in appearance with very little 
expense to the tissues. 

Q. What two cavities does the vault separate? 

A. The mouth and nasal cavities. 

Q. With what structure is the vault connected? 

A. The alveolar process. 

Q. What bones are connected with the upper border 
of the vault? 

A. The nasal bones and vomer. 

Q. Describe the vomer. 

A. This bone is situated (in its normal position) in 
the center of the nose, extends from before, back- 
ward, the entire length of the vault. It divides the 
nasal cavity into two complete cavities. The bone is 
thinnest at the median line. As it extends downwards 
it thickens. When it reaches the floor of the vault it 
gracefully curves to the right and left, making a broad 
foundation for the superior structure to rest upon. 

Q. Describe the surface of the vault. 

A. The palatal surface is very uneven ; at the suture 
is often found a ridge of bone resembling a rope-like 
section, extending a short distance, or, in some cases, 
the entire length. 



ON IRREGULARITIES OF THE TEETH. ^ 91 

Q. In what people are these irregularities found 
most frequently to-day? 

A. Among people whose nervous systems are 
unstable. 

Q. What do they seem to be? 

A. Exostoses of the bone along the line of the 
suture, due to irritation in mastication before ossifica- 
tion takes place. 

O. Is there evidence of atavism? 

A. In lower animals, such as the hare and the 
camel, there is a permanent slit in the lip. The 
tendency to cleft-palate is also an atavistic condition. 
The ossification of this suture, therefore, is very un- 
stable in character. The result is, therefore, a ten- 
dency to late ossification, resulting in exostosis. 

Q. What covers the vault upon both surfaces? 

A. Both surfaces are covered by mucous mem- 
branes. They extend backward and form the soft 
palate. 

Q. Does the hard palate vary in thickness? 

A. Yes. When it unites with the alveolar process 
it is quite thick, and also at the median line; while 
about midway between, and at the posterior surface, 
it is as thin as tissue paper. 

Q. How does the soft palate differ in different 
individuals? 

A. In a dolichocephalic head the soft palate will 
curve slowly backward, thus giving a long sweep from 
before, backwards. On the other hand, in brachy- 
cephalic heads, the soft palate will curve abruptly. In 
some cases the soft palate will drop straight down, 
thus limiting the distance from before, backward, the 
length of the hard palate. 



92 QUIZ COMPEND 

Q. Is the vault in connection with the first teeth 
ever deformed? 

A. Only very rarely and in extreme cases. Until 
the sixth year the vault is in most cases well formed. 
"The curves are all graceful in outline and the contour 
of the dental arch is well formed. This could hardly be 
otherwise, for the reason that the jaw is growing rapidly 
for the purpose of containing the permanent teeth. 

Q._ Are any two vaults just alike? 

A. They are not. They are neither alike in height, 
width nor contour, although each may be normal in 
itself. 

Q. How is the vault held in position? 

A. On the sides by the walls of the antrum, backed 
by the malar process, and the alveolar process and 
maxillary bones. 

Q. At what period does the great change take 
place in the shape of the vault? 

A. Between the period when all the temporary 
teeth are in place and all the permanent teeth have 
erupted. 

Q. Is there not a more definite time? 

A. The vault generally makes its greatest change 
after the eruption of the first permanent molars, and 
becomes fixed at the time of the eruption of the second 
permanent molars. 

Q. What change takes place? 

A. Externally the rami is quite important. If the 
person is developing normally the rami will grow in 
harmony with other structures, and the face will 
elongate. The alveolar process will grow up and down 
upon the jaws, carrying the teeth with it, until they 
antagonize. The teeth being larger and the roots 



ON IRREGULARITIES OF THE TEETH. 93 

longer, the alveolar process lengthens; this makes the 
vault higher. 

Q. Does the angle of the jaw change in other direc- 
tions? 

A. From before, backwards, it grows from an 
obtuse to a right angle. 

Q. How can the height of the alveolar process upon 
the lower jaw be judged? 

A. Early in life the mental foramen is located upon 
the upper border of the jaws. At the middle life it is 
situated midway, and sometimes two-thirds below the 
upper border. 

Q. When the rami do not develop in harmony with 
the other bones of the face, what happens? 

A. In neurotics and degenerates there may be 
arrest and excessive development of the rami, or one 
side may grow longer or shorter than the other. In 
such cases there is a marked change in the shape of 
the face. 

Q. What changes take place in the mouth? 

A. If the rami do not develop when the first and 
second molars come into place, the jaws are open in 
front, the molars only touching. When the mouth is 
closed, the vault is high. If the alveolar process does 
not develop, the face is very short, giving a youthful 
appearance to an adult face. If the rami are long, it 
gives a long appearance to the face, the alveolar pro- 
cess elongates, and the vaults are always high. 

Q. The high vault, then, is not due to its being 
pushed or pulled up by pressure exerted through the 
vomer. 

A. No, that is a physical impossibility; nor can 
the shape of the base of the skull in any way affect it. 



94 QUIZ COMPEND 

The height is due entirely to the lengthening of the 
alveolar process. 

Q. What difference is there in the height of vault 
in children and adults? 

A. In 317 children, under five years of age, it 
measured .17 lowest, .62 highest, with an average of 
.42 inches. In 4,614 adults, the lowest vault was .21, 
the highest .84, with an average of .58. 

Q. How is this demonstrated? 

A. By an instrument made for the purpose. ; The 
measurements are taken from the gum margin, at the 
neck of the second temporary molar, to the center of 
the vault; in the permanent set at the gum margin, 
between the second bicuspid and first permanent 
molar, to the center of the vault. 

Q. In comparing the height of vault of present peo- 
ples, and those of ancient skulls, how do they differ? 

A. They are a little higher than the ancient. 

Q. Can any race, sect, or intellect claim a type 
of vault? 

A. They cannot. 

Q. What does the width of the vault depend upon? 

A. The development of the jaw bone and alveolar 
process. 

Q. After an examination of thousands of skulls, 
having normal dental arches, and no two alike, how 
can a normal arch be defined? 

A. A normal vault is one where the dental arch is 
regular, and the different outlines possess graceful 
curves, regardless of height, width and length. 

Q. Are narrow arches found among early races? 

A. They are not. 

Q. Where are they found? 



ON IRREGULARITIES OF THE TEETH. 95 

A. Among modern neurotic people. 

Q. What is the direct cause of narrow arches? 

A. A neurotic, unstable brain, due to conditions 
producing arrested development of the jaws. The 
eruption of the teeth is purely mechanical, wedging 
their way into place as best they can. The arch 
becomes broken, and a V or saddle arch, or some one 
of their modifications, develops. 

Q. Does the alveolar process depend upon tooth 
arrangement for its shape? 

A. It does, and in this way the vault becomes 
narrow, and in a measure gets its shape. The height 
of vault is of little importance. 

Q. In contracted dental arches, may the vaults be 
high or low? 

A. Yes. 

Q. Is high vault ever due to contracted jaw? 

A. It is not. The vault appears to be high, owing 
to the contraction of the dental arch and the alveolar 
process. 

Q. On what does the width of the vault depend? 

A. On the development of the maxillary bones and 
alveolar process. 

Q. How must vaults be classified? 

A. By taking a large number of measurements and 
obtaining an average. 

Q. What was the result? 

A. The highest was i., the lowest .25, with an 
average of . 55. 

Q. What would be the average width of vault? 

A. By measuring a large number of jaws between 
the second bicuspid and first permanent molar; maxi- 
mum, 1.87; minimum, .75, with an average of 1.19. 



CHAPTER IX. 



DEVELOPMENT OF THE PERIDENTAL MEMBRANE. 

Q. What is the peridental membrane? 

A. It is a fibrous tissue covering the roots of the 
teeth and lining the inner walls of the alveolus. 

Q. From what layer is it derived? 

A. From the mesoblastic layer. 

Q. How does it differ from the periosteum? 

A. There is very little difference between them; 
both come from the mesoblastic layer. 

Q. Of what does the peridental membrane consist? 

A. It consists of four kinds of fibers: an outer 
layer of coarse, white, fibrous tissue, an inner layer of 
fine, white fibrous tissue, elastic fibers, and pene- 
trating fibers (fibers of Sharpey). 

Q. How do the fibers of the periosteum differ from 
those of the peridental membrane? 

A. Those of the periosteum are coarse, and run 
parallel with the alveolar process over the border and 
extend as far as the union of the epithelial layer and 
the periosteum. [The Dental Ligament. Black.] 

Q. Where do the fine fibers extend? 

A, They extend in all directions, and enter the 
alveolar process at every point. 

Q. How do they look under the microscope? 

A. If a section of the alveolar process be treated 
with acids, or a section affected with osteomalacia be 
placed under the microscope, the fibers will be seen to 
retain the original shape of the bone. 

97 



98 QUIZ COMPEND 

Q. Are the fibers continuous throughout the peri- 
dental membrane, alveolar process and periosteum? 

A. They are. 

Q. Has the periosteum a blood supply? 

A. It is very rich in blood vessels. They anasto- 
mose with each other and enter the alveolar process in 
all directions through the Haversian canals and 
vessels of Von Ebner. 

Q. Are they more numerous in this locality than 
in connection with other bones? 

A. Owing to the transitory nature of the peridental 
membrane and alveolar process, they are. 

Q. What function has the peridental membrane? 

A. It fills the space between the root of the tooth 
and the alveolar process, being a cushion for the teeth 
to rest upon. It is present when the teeth are present 
to furnish nourishment. It holds the teeth in their 
sockets. 

Q. What other functions have the fibers of the 
peridental membrane? 

A. It is a mesh which holds the lime salts in posi- 
tion. 

Q. Where does calcification commence? 

A. At the center of the jaw. It gradually fills in 
until the fibers of peridental membrane become very 
thin, and in old age it is almost entirely lost. 

Q. What are the "fibers of Sharpey?" 

A. They are fibers of connective tissue that pene- 
trate radially from the peridental membrane, or per- 
iosteum, or outer lamellae of bone into the deeper 
layer. 

Q. How are the fibers of Sharpey arranged? 

A. The fibers extend in all directions, but do not 



ON IRREGULARITIES OF THE TEETH. 99 

enter, as claimed by Gray, like so many tacks driven 
into a board, uniformly and regularly. In some local- 
ities they penetrate in large quantities, and almost 
surround a piece of bone; again, a few fibers pene- 
trate only a short distance. In other places they can 
be traced a long distance. 

Q. How do these fibers compare with those in lower 
animals? 

A. They are much finer in man. 

Q, Are the fibers elastic? 

A. They are. A tooth can be turned half way 
around by stretching the fibers, without breaking. 

Q. When are the fibers most elastic? 

A. In youth, becoming less so as age advances, 
when the membrane grows thinner, and almost a bony 
union has taken place. 

Q. When inflammation sets in, what becomes of 
the earthy substance? 

A. When inflammation sets in as a result of death 
of pulp or from auto-intoxication, it becomes inter- 
stitial in character, and the lime salts are absorbed. 
Nothing is left but fibrous tissue. This holds the tooth 
in place, although it moves backward and forward. 

Q. Do blood vessels exist in the alveolar process? 

A. Yes. Some run in straight from the peridental 
membrane and periosteum, others run diagonally, 
others lengthwise. They run in all directions, close 
to the bone rather than near the root of the tooth. 

Q. Why? 

A. There are no arteries normally penetrating the 
sides of the root; nourishment is not required at that 
part of the membrane. 

Q. How may these blood vessels be seen? 

L.ofC. 



100 QUIZ COMPEND 

A. By injecting the carotid artery of a dog, and 
placing a section of alveolar process under the micro- 
scope. 

Q. Are the alveolar process and surrounding tis- 
sues rich in vascular supply? 

A. Yes. Especially in the young, owing to the 
transitory nature of the structure. 



CHAPTER X, 



DEVELOPMENT OF THE TEETH. 

Q. What were the teeth at their origin? 

A. They were primitive organs of the skin. Accord- 
ing to Minot they were placoid scales, which were 
dermal teeth of the shark. 

Q. What became of the scales in the advance of 
evolution? 

A. They became cartilaginous in the human 
embryo and assisted in development of the skull 
bones. 

Q. What became of them later? 

A. They dipped into the epidermis, and calcifying, 
formed the enamel of the tooth, which fitted around 
a soft core or pulp. The tooth departs from the prim- 
itive method of development since it does not arise 
from the surface, but deep down in the tissue. 

Q. How is the tooth formed? 

A. The structure grows down into dermis, forming 
an oblique shelf, which is a special tooth-forming 
organ. On the under side of the shelf the teeth are 
developed the same way as over the skin, although 
they are very much larger. 

Q. Do the teeth develop as in man? 

A. They do not They are in various stages of 
development, and only one is fully exposed at a time. 
When one tooth has exceeded its usefulness, it falls 
out and another tooth takes its place. Thus they 
continue to d^V^lop indefinitely. 

101 



102 QUIZ COMPEND 

Q. What is this condition called? 

A. It is called polyphyodontia. 

Q. How many sets of teeth have mammals, as a 
rule? 

A. Two sets. The condition is called diphyodontia. 

Q. How are the teeth united in the shark? 

A. By a small plate of dermal bone at the base. 

Q. How do the teeth develop in mammals, as a 
rule? 

A. By a modification of the jaws, the epidermis 
dips down into the dermis, and the enamel is devel- 
oped. The first indication is a thickening of the 
mucous membrane at the sixth week of embryonic 
life. This ridge dips downward from the epithelial 
cord. This expands, forming the dental shelf. The 
papilla, comprised of blood vessels and fibrous tissue, 
develops beneath, taking the shape of the tooth that 
is to form. The dental shelf forms around the 
papillae and forms the enamel. 

Q. Where are the dental sacs located? 

A At the inner border of the jaw. This gives 
room for the germs of the second set to develop at the 
outer border. 

Q. Where are the enamel organs for the last 
molars obtained? 

A. The dental shelf is prolonged from the last 
teeth without retaining the direct connection with the 
epithelium. 

Q. In the order of evolution, how do the teeth 
evolve? 

A. The mammal teeth pass in evolution from the 
simple types of the oviparous edentate'^to those of the 
indeciduous ancestors of the sloths and armadilloes 



ON IRREGULARITIES OF THE TEETH. 103 

and their descendants, including the dolphin and 
whales, whose teeth (in the foetal Greenland whale 
and adult sperm) preserve the old type. In the 
edentates these teeth may be few; in insectivorous 
mammals, approximating those of the reptilian in 
number, sixty or seventy on a side. 

Q. How are the human teeth evolved from the 
primitive cone tooth? 

A. They are evolved by both concrescence and 
differentiation. 

Q. Has the tooth received much attention from 
anthropologists and ethnologists? 

A. It has not. Flower has constructed a dental 
index by multiplying the dental length by ioo, and 
dividing by the basio-nasal length. 

Q. What are his results? 

A, Caucasic races are microdont (with small teeth 
and small dental index) ; the Mongol ic races mesodont 
(middle teeth and index) ; the Negroid races are 
megadont (great teeth and index). The anthropoid 
apes have still larger teeth and indices. 

Q. After the teeth are formed, what becomes of the 
rudiments of the enamel organ? 

A. These remain in the deeper structures. When 
the teeth push their way through the gum, these 
epithelial cells are pushed to one side, and they remain 
encased in the peridental membrane. 

Q. What has lately been claimed in regard to these 
epithelial cells? 

A. It has been alleged that they are glands. 

Q. What theory was advanced by Kollman and 
Gegenbauer? 

A. That they are abortive rudimentary survivals 



104 QUIZ COMPEND 

from an ancestral condition in which the teeth are 
numerous, as observed in the shark. 

Q. What theory did Robin and Magitot advance? 

A. They claimed that they were epithelial debris, 
a view perfectly compatible with that of Gegenbauer 
and Kollman. 

Q. What other views have been advanced? 

A. The other views corroborate those of Robin and 
Magitot, since epithelial cells may be found imbedded 
in the derma in all parts of the body. 



CHAPTER XL 



SOCIAL CONSANGUINITY, NEAR-KIN, EARLY AND 
LATE MARRIAGE. 

Q. Has the influence of intermarriage in families 
been overestimated as a factor in producing defect? 

A. From the general principles of heredity, already 
laid down, it must be obvious that the influence of 
inter-marriage in families has been overestimated as 
a factor, per se, in the production of defect. 

Q. Is there an advantage in cross-breeding? 

A. The idea of the advantage of cross-breeding, 
which seemingly appeared in the practice of exogamy 
(marriage outside the tribe, or more often outside 
those having the same totem or coat-of-arms) arose 
from observation of deformities following intermar- 
riages contracted after the killing of girls for econ- 
omic reasons had led to exogamy. 

Q. What was the origin of incest? 

A. It was of religious origin rather than innate, 
since the totemic relationship (which was chiefly pro- 
hibited) was often far from being consanguinous. 

Q. What was the totem? 

A. It was a mark indicating descent from a sup- 
posed animal ancestor endowed with occult powers. 

Q. Could the children with the Bear totem of one 
tribe marry those having the same totem in another 
tribe? 

A. No. 

Q. What notions sprang from this practice? 

105 



106 QUIZ COMPEND 

A. The medical, theologic and legal notions anent; 
the danger from marriage of consanguinity, which 
was insisted upon from time to time by medical 
writers, has been recognized by ecclesiastic authority, 
civil law and by popular feeling. 

Q. Has the marriage of near relations been for- 
bidden? 

A. By ecclesiastic and civil law, marriage of those 
very nearly related has been forbidden on other 
grounds than that of alleged danger to offspring. 

Q. Does the justice of such laws receive support? 

A. Such laws receive support from medical obser- 
vations, which tend to show that intermarriage may 
produce degeneracy, idiocy and insanity. 

Q. Has this evidence been analyzed? 

A. Yes. There is more than one explanation of 
the facts. 

Q. Where lies the chief danger in intermarriage? 

A. With a perfectly healthy stock, as every breeder 
of animals knows, 4t in-and-in" breeding may be prac- 
ticed with impunity, but where the stock is tainted 
with disease or imperfection, safety is only to be found 
in "crossing. " 

Q. What was the error of the old doctrine? 

A. The error of the old doctrine upon which was 
founded the prohibition of consanguinous unions lay, 
not in asserting that disease and deformity were more 
often met with in children of these than those of 
other unions, for such is the fact, but in attributing 
these unhappy results merely to parental blood kin- 
dred. 

Q. Is there a physiologic reason why these mar- 
riages should not take place? 



ON IRREGULARITIES OF THE TEETH. 107 

A. Over and above the fact that these consanguinous 
marriages are almost certain to transmit, in an accen- 
tuated form, defect or tendency to disease, already 
present in the family, there is no physiologic reason 
why such marriages should not take place. 

Q. Can prize stock in-and-in breeding be beneficial? 

A. Breeders of prize stock frequently breed in-and- 
in, not only with impunity, but with marked benefit. 

Q. Does this prove that degeneracy found in 
children of consanguinous marriages does not result 
from this? 

A. But this fact, while going to prove that it is 
not the mere blood relationship of the parents which 
induces the degeneration so often found in the children 
of consanguinous marriages, can but rarely be 
advanced as an argument in support of the marriage 
of blood relations. 

Q. How does the stock raiser propagate the same 
kind? 

A. The stock raiser only permits the more perfect 
members of his flock and herds to continue their kind; 
for this reason "in-and-in'' breeding is innocuous, 
just as it would be in the human family under like 
conditions. 

Q. Do acquired characters disappear with inter- 
marriage? 

A. Recently acquired characters, whether physio- 
logic or pathologic, are very liable to disappear when 
the individual having such characters intermarries with 
another not having the same character. 

Q. What is the natural tendency of the offspring? 

A. In all such cases, to revert to the normal type, 
so that unless the new character be very deeply 

9 



108 QUIZ COMPEND 

impressed upon the parental organism, it is almost 
certain it will not appear in the offspring of the other 
parent having nothing of the character. 

Q. Is the character often repeated in an accen- 
tuated form in the offspring? 

A. When both parents are possessed of the charac- 
ter, whether it be physiologic or pathologic, this 
natural tendency to revert to the original is often 
overborne, and the character is repeated in an accen- 
tuated form in the offspring. 

Q. What happens in the case of consanguinous 
marriages? 

A. This accentuation of family character always 
takes place. 

Q. Will taint be inherited? 

A. Each member will inherit more or less of it 
from the common ancestor. 

Q. Cite the case of cousins. 

A. The descendants of a common grandparent, 
insane and of insane stock, are certain to have 
inherited more or less of the insane diathesis. Even 
if the taint have been largely diluted in their case 
by the wise or more likely fortunate marriages of 
their blood related parents, yet, still they have 
inherited a certain tendency to nervous disease, and 
if they marry they must not be surprised if that 
taint appear in aggravated form in their children. 

Q. Can parents always account for the imper- 
fections? 

A. The blood kindred parents of idiotic, epileptic, 
dumb or lymphatic children often marvel whence 
come these imperfections. 



ON IRREGULARITIES OF THE TEETH. 109 

Q. Is there always evidence to show that tendency 
to disease may be inherited? 

A. In some cases the parents, and possibly the 
grandparents, of the unfortunate children have not 
displayed any obvious evidence of the tendency to 
disease, which they have inherited and handed on to 
their descendants. 

Q. Will parents deny the inheritance of certain 
diseases? 

A. Yes. Not looking farther back, parents assert 
that insanity, epilepsy, scrofula, etc., are unknown to 
their family, They have never been so afflicted; why 
should their children? In like manner children may 
be epileptic, blind, deaf mute, lymphatic, cancerous, 
criminal, drunkards or deformed from direct inherit- 
ance, and yet the family line be honestly declared 
healthy in these particulars. 

Q. Is the truth of Sir William Aitken's maxim 
obvious? 

A. Yes. A family history, including less than 
three generations, is useless, and may even be mis- 
leading". 

Q. Is social consanguinity a potent factor in here- 
ditary degeneration? 

A, Similarity of temperament, induced by a com- 
mon environment, called "social consanguinity, " is a 
potent factor in the production of all hereditary degen- 
eration. 

Q. Will similar customs, habits, surroundings, etc., 
produce like diseases? 

A. Yes. They tend to engender like diseases and 
degenerations, irrespective of any blood relation- 
ship. 



110 QUIZ COMPEXD 

Q. Do socially consanguinous people, not even dis- 
tantly related, often resembled each other? 

A. Yes. They are in reality much more nearly 
related in temperament than cousins, or even nearer 
blood relations who have experienced widely different 
modes of life. 

Q. What is social consanguinity? 

A. The curse that dogs every exclusive tribe and 
class and hurries them to extinction. It is the chief 
factor in the production of the disease and degener- 
ations which have stamped themselves upon royal 
families. 

Q. Is this condition found in neurotic marriages? 

A. This social consanguinity appears likewise in the 
tendency of the neurotic to intermarry, popularly 
expressed in the proverb that "like clings to like." 
The marital tendency from this likeness in mental 
characteristics has been shown to be present, by recent 
medical writers, so far as Germany, France, and the 
United States are concerned. 

Q. What is the statistical evidence? 

A. There are in Illinois, according to the most 
recent estimates, in round numbers, about 6,000 
insane, or one to a little over 500 of the population. 
Even if we double, treble, or quadruple this fre- 
quency, to include all that have been, or are to be 
insane, as well as those insane at the present time, it 
would not appear that there was much probability of 
two insane persons being married, according to any 
ordinary law of chances. In fact, we find four out of 
104 with insane heredity where both father and mother 
were insane. In one of these cases the insane heredity 
involved both parents and grandparents on each side, 



ON IRREGULARITIES OF THE TEETH. Ill 

though in the case of the latter the histories show it 
only as collateral. Besides these three patients, two 
had direct maternal and collateral paternal hered- 
ity, and in one case there was collateral heredity 
of insanity on both sides. This makes altogether 
nearly ten per cent, of those with insane heredity with 
it on both sides, maternal and paternal, and thus 
favored with a double opportunity to inherit mental 
disease. If to this be added the instances where, with 
insanity of one parent there is either epilepsy, hysteria, 
or drunkenness, brain disease, nervousness, etc., of 
the other, the ratio of double inheritance rises to 
over twenty per cent. 

Q. Is much taint required to cause degeneration of 
the face, jaws, and irregularities of the teeth? 

A. Since the jaws and -face are transitory struct- 
ures, relatively little taint is needed in a family or 
community to cause degeneration of the face and 
jaws, and irregularities of the teeth. 

Q. Is this factor overestimated in deformities of 
neurotics? 

A. The influence of these neurotic and social con- 
sanguinity tendencies in the production of deformities 
of the face and jaws and irregularities of the teeth 
cannot well be overestimated. 

O. Cite a test of these influences. 

A. A test of these influences is alleged to exist in 
the Polynesian population of the Pacific Islands, where 
race admixture can be excluded for a relatively long 
period. It was claimed that here was a people isolated 
from all others for at least 1,400 years, with no admix- 
ture of races, yet irregularity of the teeth of both max- 



112 QUIZ COMPEND 

illse was almost as common as it is among the mixed 
races of to-day. 

Q. What is to be peculiarly reckoned with the 
Polynesians? 

A. Excessive licentiousness shown in societies for 
the practice of extreme sexual indulgence like the Areoi. 

Q. What do these societies create? 

A. They create neurotic states and tendencies, and 
produce more marked degeneracy of the face, jaws 
and teeth than intermixture of race or consanguinous 
marriage. 

Q. Can the factors of race admixture be excluded 
from the ancient Hawaiians? 

A. As the Polynesians and Malays are great navi- 
gators, it cannot be completely excluded from consid- 
eration. 

Q. Will leprosy, like syphilis, check development 
without causing infection in utero? 

A. This factor has likewise to be taken into consid- 
eration. 

Q. Has the mortality among Hawaiian babies been 
large? 

A. Yes. 

Q. What are the conditions as to hygiene? 

A. Hygiene is practically unknown. 

Q. What is the medicinal agent of the Kahuna 
(sorcerer-medicine man)? 

A. An intoxicant, kava-kava (the fermented juice 
of the awa). 

Q. Is syphilis common? 

A. Yes. Especially the non-venereal type. 

Q. Do the habits of the natives aid the spread of 
the disease? 



ON IRREGULARITIES OF THE TEETH. 113 

A. Yes. 

Q. What is the result? 

A. Under such conditions, irregularities are fre- 
quent. 

Q. Is the age of the mother at pregnancy ignored 
in dealing with defects? 

A. Yes. It was pointed out two decades ago that 
the offspring of early and senile marriages were 
defective and multiple, and too nearly repeated preg- 
nancies were of frequent occurrence. 

Q. What often determines degeneracy? 

A. In all degenerate forms, age of the parent 
must be taken into consideration. 

Q. What investigations have been made as to the 
age of parent upon degeneracy? 

A. The age of mothers of degenerates is often 
below twenty-five years. In an investigation of the 
influence of the age of parents on the vitality of 
children, found that the proportion of deaths among 
children from unhealthy constitutions or maladies 
traceable to the mother was twice as large among the 
children of mothers under twenty as among the 
children of mothers over thirty. The healthiest off- 
spring are born of mothers between twenty and thirty, 
united to husbands between thirty and forty. Where 
either husband or wife-was under twenty, the offspring 
usually proved weakly. This is particularly the case 
even in Hungary, where the girls become women at 
thirteen. In that country, in twenty-five per cent, of 
the number of marriages, the brides are under twenty 
years of age. 

Q. What has been found in regard to criminals? 

A. Among all classes of criminals there is an 



114 QUIZ COMPEND 

excess of immature parents (under twenty-five) or 
senile parents (over forty-two). 

Q. What is a well-known fact? 

A. It is a well-known fact that children of the aged 
exhibit degeneracy. 

Q. Does premature and late marriage have an 
influence in the production of idiocy? 

A. They have been recognized as having great 
influence. 

Q. At what stage may arrest of foetal development 
take place in idiocy? 

A. Factors capable of the production of idiocy may 
arrest foetal development at all stages. 

O. Cite a case. 

A. In a Nova Scotian family, of Scotch extrac- 
tion, the mother still continued to bear children until 
she was sixty-three years old. There had been no 
pregnancy between fifty and fifty-six. At fifty-six a 
son was born, who had ear, jaw and skull stigmata, 
and became a periodical lunatic at twenty-five. A 
son, born a year later, was a six-fingered idiot, with 
retinitis pigmentosa. Three of the next children 
were paralytic idiots in infancy. One of the next 
children was a periodical sexual invert female. The 
last child was an epileptic. The children born before 
the age of fifty were normal and averaged sixty years 
of age, 



CHAPTER XII. 



ENVIRONMENT, CLIMATE, SOIL AND FOOD. 

Q. Was the influence of climate, soil and food, and 
other factors early observed? 

A. Yes. 

O. What seeming modifications have been pro- 
duced? 

A. Even skeptical biologists admit that "the possi- 
bility is not to be rejected that influences continued 
for a long time (that is for generations and genera- 
tions, such as temperature, climate, kind of nourish- 
ment, etc.), which may affect the germ plasm as well 
as any other part of the organism may produce a 
change in the constitution of the germ plasm. But 
such influences would not then produce individual 
variations, but would necessarily modify in the same 
way, all the individuals of a species living in a certain 
district. It is possible, though it cannot be proved, 
that many climatic varieties have arisen in this man- 
ner. Possibly other phenomena of variations must be 
referred to a variation in the^ structure' of the germ 
plasm produced directly by external influences. " 

Q. Upon what does climate depend? 

A. The influence of climate depends upon more 
than the mere range of temperature and meteorologic 
elements. 

Q. What does transferral from a sub-temperate to 
a sub-tropic clime mean?- 

A. It means not merely a change in the necessity 

115 



116 QUIZ COMPEND 

for adaptation to temperature alterations, but also 
change in the ease with which food is secured and the 
stress of struggle for existence to which man has been 
exposed, 

Q. What has soil and climate produced on one 
people? 

A. The Wurtemburgers settled thirty-two years 
ago near Tiflis, Russian Georgia. They originally had 
fair or red hair, light or blue eyes, and coarse, broad 
features. In the first generation, brown hair knd 
black eyes became the rule, while the face acquired a 
noble, oval form. 

Q. Were these changes due entirely to surround- 
ings? 

A. Yes. There is no record of intermarriage with 
the Georgians. 

Q. Did the Wurtemburgers continue to speak 
German? 

A. Yes. 

Q. Who were the Wurtemburgers? 

A. A mixed race, in whom the surroundings in 
Wurtemburg tended to develop one type, while those 
in Georgia developed another. 

Q. Were there changes in the face, jaws and teeth? 

A. Yes. These changes in . type became clearly 
evident. 

Q. What was the original Wurtemburger type? 

A. Arrested facial development and prognathism, 
which disappeared under the favorable conditions of 
Russian Georgia. 

Q. What similar changes is alleged elsewhere? 

A. The alleged transformation of the Britisher into 
the Yankee, charged to the effects of climate and soil. 



ON IRREGULARITIES OF THE TEETH. 117 

O. What is this alleged change? 

A. The Yankee presents features of Indian type. 
The glandular system is reduced to the minimum of 
its normal development. The skin becomes like 
leather. The cheeks are sallow, the head smaller, 
rounder, and covered with stiff, dark hair. The neck 
is longer. The cheek bones and masseters are more 
developed. The temporal fossae become deeper, the 
jawbones more massive, the eyes lie in deep approxi- 
mated sockets. The iris is dark, the glance is piercing 
and wild. The long bones, especially in the superior 
extremities, are lengthened, so that the gloves manu- 
factured in England and France for the American 
market are of a peculiar make, with long fingers. 
The male pelvis approaches that of the female. 

Q. Has America thus produced a new white race? 

A. According to Quartrefages, Pruner Bey, and 
others, this production of the Yankee from the English 
might be called a new white race. 

Q. Is this hypothesis correct? 

A. No. The reverse is true. 

Q. Does this admit demonstration? 

A. Yes. The following instance is one of many 
that could be mentioned. In a New England family, 
with a Scandinavian patronymic, the first generation 
(born in 1761) is represented by a dolichocephalic 
head, with massive jaws and lips (especially the upper) 
prominent. The nose is long. The eyes are set close 
together. The forehead is very high and straight. 
In the second generation the face is not so long. The 
lateral diameter is larger. The forehead is more 
prominent. The eyes are a little farther apart. The 
nose is about the same length. While there is a gen- 



118 QUIZ COMPEND 

eral resemblance about the mouth and chin, the dis- 
tance from the front of the chin to the tip of the nose 
is not quite as long. In this the shortening of the chin 
has played apparently the chief part. In the third 
generation, the forehead is broader and less retreating 
than in the second. There is less prognathism and 
less prominence in the supra-orbital region. In the 
fourth generation appears a brachycephalic type of 
head. It is nearly round. The forehead is full. The 
eyes are set in the head to correspond with its width. 
The nose is broad. The upper lip is short. The 
lower jaw is much broader than in the first generation, 
and is evidently shorter, in a perpendicular line. 
These changes result from the formation of a protrud- 
ing forehead, receding chin, and delicate features. 

Q. What must also be taken into consideration 
besides climate? 

A. Modes of life. 

Q. Is the distinction once made by anthropologists 
between tropic and non-tropic races now tenable? 

A. No. Experience of the British in India, and of 
the Hollanders in Java, has shown that with change of 
habits and food suited to environment, Europeans 
may not only live in the tropics with impunity, but 
may improve under the advantages these have over 
sub-arctic and temperate zones. 

Q. To what are these possibilities due? 

A. To the consequence of sound sanitation. 

Q. What effects has hygiene had? 

A. ''The fairest laurel practical hygiene may boast 
of to-day is, " as Gihon remarks, k * doubtless the laurel 
acquired in ameliorating the sanitary conditions of the 
European in tropical climates." 



ON IRREGULARITIES OF THE TEETH. 119 

Q. What did James Lind remark a century ago? 

A. Much more than ta climate yoti are indebted to 
your own ignorance and negligence for the disease 
from which you suffer in tropical climates. 

Q. What do modern researches tend to show? 

A. That the vital resistance of the different races 
in tropical climates depends more on external condi- 
tions than on race. 

Q. What must be observed by strong, healthy 
Europeans of both sexes to live in tropical climes? 

A. They must assiduously observe hygienic rules. 

Q. What has been shown in regard to sterility of 
Europeans in tropical regions under unchanged habits 
of life? 

A. That Europeans are not able to produce more 
than three or four generations of true European blood, 
and that from the third or fourth generation onward, 
sterility is the rule. 

Q. Is there an opportunity to test this statement? 

A. The permanent establishment of an American 
colony in the Philippines will decide this. 

Q. What other important factors must be consid- 
ered in connection with climate? 

A. Dietetics, as well as moist and dry heat. 

Q. What effects are these last liable to produce? 

A. Neurasthenia, with co-existing and complicating 
auto-intoxication. 

Q. How do these two affect the tissues of the 
mouth? 

A. They alter nutrition of the alveolar process, 
producing interstitial gingivitis and absorption. 

Q. Cite an illustration of this. 

A, A twenty-three-year-old man has been in the 



120 QUIZ COMPEND 

Philippines for a year and seven months. He was 
one of the first volunteers to reach Manilla after the 
naval battle. Nineteen months' life in the tropics on 
the usual army rations has resulted in the loss of 
nearly every tooth. While the climate undermines 
the nutrition of the alveolar process, and tropical 
fevers have the same effect, improper diet increases 
the defect. The teeth dropped out, one by one, as is 
commonly the case with Americans in the Philip- 
pines. 

Q. How has the English-speaking race demon- 
strated its ability to endure all climates? 

A. The types now forming in South Africa and 
Australia recall the New England and Kentucky type 
of the eighteenth century, but will doubtless pass, like 
it, into a type resembling that of the fourth generation 
illustrated. 

Q. Is this race, in its own home, mixed? 

A. Yes. In its colonies it is still more so, but 
despite this, preserves relatively permanent mental 
and physical racial characteristics. 

Q. What effect does the struggle to maintain 
mental states produce? 

A. The variations in the teeth and jaws noticeably 
present in the English-speaking races. 

Q. Where are similar effects observable? 

A. The Scandinavian speaking races, who resem- 
ble them in racial admixture and adaptability to 
climate, have the same tendencies in relation to jaws 
and teeth. 

Q. How is it evident that climate does not exercise 
the influence once claimed for it? 

A. Thirty years ago, government authorities 



ON IRREGULARITIES OF THE TEETH. 121 

claimed it was impossible for human beings to live 
the entire year in Minnesota, owing to the extreme 
cold in winter. Now, not only is the soil cultivated 
throughout the entire state, but still farther north, in 
Manitoba, a large city has sprung up, surrounded by 
a very considerable farming population. The influ- 
ence of climate, therefore, can be guarded against by 
man much more than any factor of his environment. 

Q. What effect has altitude on physiologic charac- 
teristics? 

A. While, as a rule, residents at high altitudes are 
strong, robust, buoyant, and of great mental and 
physical endurance, there are numerous exceptions. 
Thus "the engineers and workmen on the Jungfrau 
railway, obliged to remain a considerable time at alti- 
tudes of about 2,600 meters above the sea-level, are lia- 
ble to a disagreeable complaint. After eight or ten days 
they are seized with violent pains in several teeth, on 
one side of the jaw, the gums and cheek on the same 
side becoming swollen. The teeth are very sensitive 
to pressure, so that mastication is extremely painful. 
These symptoms increase in severity for three days, 
and then gradually and entirely disappear. It seems 
to be purely a phenomenon of acclimatization. All 
newcomers pass through the experience, and the dis- 
order never recurs." The influence of heat, of cold, 
and of barometric pressure shown in a lesser degree 
in "mountain fever" produces systemic disturbance 
of metabolism, which, causing auto-intoxication, 
markedly affects the alveolar process, producing inter- 
stitial gingivitis. 

Q. Where are effects of soil upon growth most 

obvious? 
10 



122 QUIZ COMPEND 

A. In goitre and cretinism. 

Q. Are primitive races affected? 

A. Unsanitary surroundings, depressing constitu- 
tional conditions, improper and excessively nitrogenous 
diet, produce, among Indians, goitre and bone changes 
often associated with it. 

Q. How may the influence of food producing sys- 
temic changes which involve interference with proper 
osseous development be divided? 

A. Into two factors. One involving the quality of 
the food, and the other its quantity and variety. 

Q. What is one most striking illustration of the 
first factor? 

A. The constitutional skin, nervous and mental 
disorder, pellagra, found in France and Italy. 

Q. How is the disorder produced? 

A. While unhygienic surroundings play a part, 
pellagra is chiefly due to spoiled maize, taken as a food. 

Q. Wherein are its osseous effects evident? 

A. The frequency of jaw and teeth stigmata dem- 
onstrates the effect of pellagra. 

Q. What other,conditions of diet affect the osseous 
system? 

A. Monotony of diet is likewise an emphatic cause 
of constitutional nervous disorders, such as distort 
osseous development. 

O. What other conditions are brought about by 
monotony of diet? 

A. Monotony of diet and surroundings undoubt- 
edly produce a large amount of degeneracy in families 
of pioneers in the United States, and of farmers in 
secluded valleys of Norway, Switzerland, and else- 
where. 



ON IRREGULARITIES OF THE TEETH. 123 

Q. What effect has it upon the farmer families? 

A. There is an unusual quantity of insanity in 
families, traceable to this condition. 

Q. Cite an illustration. 

A. The mother, a member of New England stock, 
of tireless energy, to whom work was a pleasure and 
rest an abhorrence, lived on a farm, miles from the 
town. She did all her own work and brought up 
a large family, chiefly on maize, potatoes, and bread, 
pork being the meat diet. At fifty this woman re- 
moved with her husband, who had grown wealthy, to a 
small country town. Here she conducted the work of 
the household without a servant. At fifty-two she 
broke down with neurasthenia, which rapidly passed 
into periodical gloomy spells, in one of which she com- 
mitted suicide. Her youngest daughter, who had a 
symmetrical face, has the gloomy tendency of the 
mother, alternating with periods of restlessness, 
which evince themselves unnecessarily in doing the 
work of the servants and other labors inconsistent 
with her husband's social status. She had at times 
suicidal and homicidal impulses. She has three 
children; one exhibits no special abnormality; the 
eldest, a boy of eleven, dislikes to play with boys, 
because they are rough, plays with girls, to whom he 
is at times mischievously cruel. He likes to sew 
dolls' clothing and purchase dolls, while there are 
other indications of sexual abnormalit}^. The youngest, 
a girl, has frequent attacks of epileptic-like fury, 
although between these she is kind-hearted, good- 
humored, and very affectionate. 

Q. What does the fungus on maize (ustilago) like 
the fungus on rye (ergot) produce? 



124 QUIZ COMPEND 

A. A rather long-lasting neurosis of epileptic 
character, susceptible of transmission to the offspring 
of women poisoned with fungi. 

Q. What effect does a vegetarian diet have? 

A. It seems to be deteriorating to the races who 
are restricted to it alone. These races -are cowardly, 
meanly cruel, extremely mendacious, untrustworthy, 
weak in stamina, and readily yield to morbid influences. 

Q. What effect does potato diet have upon the 
Irish Celt? 

A. The influence of potato diet in degenerating 
the Irish Celt in comparison with the Scottish Celt, 
under the same conditions, is difficult at present to 
determine, for lack of data. Certainly the descendants 
of this class of Irish Celts rapidly regain a handsome, 
healthy status under mixed American diet, even 
though the hygienic surroundings in the great cities 
be not the best. 

Q. What does the physician find who undertakes 
to treat a class of neurasthenics, in whom starch diges- 
tion is impaired? 

A. He finds that a diet of potatoes (undoubtedly 
through the auto-intoxication it produces) will increase 
certain nervous symptoms, and hence the tendency 
to transmission to the next generation. 

Q. How is this widespread influence of nutrition 
excellently illustrated? 

A. In the conditions produced in children, and in 
the insane, by improper food, and the reaction of 
these to hygienic diet. 

Q. What may improper diet produce in the child? 

A. It will produce all possible nervous disorders, 
including those involving the trophic processes. 



ON IRREGULARITIES OF THE TEETH. 125 

Q. In what diseases is this peculiarly evident? 

A. Scurvy and rickets and their effects on- the gen- 
eral osseous development. Improper maternal diet 
during pregnancy may produce similar effects. 

Q. Has the influence of maternal environment 
upon the foetus been much underrated? 

A. Yes. Because of the belief that the plaeenta, 
by its filtering and poisoning-destroying functions, 
protected the foetus. 

Q. Has this been shown to be an error? 

A. Yes. Especially in arrests of development 
produced by the toxins of the great contagions. 

Q. What did later investigations show? 

A. That not only did organic poisons, like opium, 
pass through the placenta, but that mineral poisons, 
like lead, did also. Children of opium using mothers 
died in the first months after birth, unless given 
opium. It was later shown that in such cases the 
umbilical cord contained large quantities of morphine. 

Q. What is known as to children of mothers work- 
ing in tobacco factories? 

A. They exhibited very little vitality, and much 
deformity. 

Q. What effect has tobacco-working on maternity? 

A. Maternal work in tobacco factories is a cause of 
frequent miscarriage, of high infantile mortality, of 
defective children, and of infantile convulsions. 

Q. What has been observed in regard to mineral 
poison? 

A. Lead and phosphorus pass through the placenta 
and enter the child's circulation. 

Q. What is the effect upon the system? 

A. It has been found that those exposed to its 



126 QUIZ COMPEND 

fumes have systemic nervous exhaustion, character- 
ized by local paralysis about the wrist, as well as the 
general symptoms of profound systemic nerve-tire. 

O. What may happen? 

A. This may result in acute insanity of the con- 
fusional type, followed very often by forms of mental 
disorder of a chronic type resembling paretic dementia. 

Q. What may follow should there be a recovery? 

A. Epilepsy ; in other cases, an irritable suspicional 
condition results, in which the patient may live for 
years, marry, and leave offspring. This last condition 
and the epileptic are the most dangerous as to the 
production of degeneracy* 

Q. Give an example. 

A. Women employed in the pottery factories suffer 
from a form of lead poisoning, which produces decid- 
edly degenerative effects upon the offspring. These 
women have frequent abortions, often produce deaf- 
mutes t and very frequently macrocephalic idiots. 

Q. What effect does brass dust have upon work- 
men? 

A. They suffer from a very similar condition to 
that produced by lead. Grave forms of nervous 
exhaustions occur among brass workers. 

Q. Do women become exposed to these conditions? 

A. Yes. The effect produced, so far as the off- 
spring has been observed, are frequent abortions and 
infantile paralysis. 

Q. What effect has mercury upon the system? 

A. It produces systemic nervous exhaustion, in 
which the most marked symptom fs tremor, amount- 
ing at times to shaking palsy. 

Q. What effect does this have upon the offspring? 



ON IRREGULARITIES OF THE TEETH,' 127 

A. Like all other nervous exhaustions, the mer- 
curial one may appear as degeneracy in the offspring. 

Q. What is the effect upon women who work in 
match factories? 

A. The chief toxic effect of phosphorus is not the 
localized jaw necrosis. This is an evidence of the pro- 
gressive system-saturation with phosphorus. It bears 
the same relation to the dangerous effect of phos- 
phorus that "blue gum" does to the systemic effects 
of lead. 

Q. What is the effect of carbon bisulphide? 

A. Those who come in contact with it have been 
noted to suffer from the initial stages of interstitial 
gingivitis. Recently cases are reported where twenty 
young women, employed in rubber factories, exhibited 
a necrotic process in the jaws and teeth similar to that 
resultant on phosphorus. 



CHAPTER XIII. 



RACE ADMIXTURE. 

Q. Is race admixture slight? 

A. It has been greatly underestimated. 

Q. To what is this due? 

A. Ethnic researches have lately thrown much 
doubt on the standards set up as race tests. 

Q. What has been assumed? 

A. That a clear distinction can be made on philo- 
logic grounds between different races, and that even 
Aryan-speaking races can be easily separated. 

Q. Can this be accomplished? 

A. Ethnology has shown this to be an error, and 
that speech is no test of race. 

Q. Are the races of Europe pure? 

A. No. Not merely are the Aryan-speaking races 
of Europe mixed together, but the blood of all has a 
pre- Aryan and a Turanian dash. 

Q. How far back do these admixtures date? 

A. To palaeolithic times, when, although the pre- 
dominant type of skull was dolichocephalic (or long- 
headed), brachycephalic (round-headed type) had 
begun to appear in America, then connected by land 
with both Africa and Europe. In subsequent neo- 
lithic times, while the type is at first generally 
brachycephalic, it soon becomes mesocephalic (mixed 
long and round headed), pure brachycephalic and 
dolichocephalic becoming rare. 

129 



130 QUIZ COMPEND 

Q. Is this race admixture true of American 
Indians? 

A. Even the race type called the American Indian 
still so retains traces of the race elements forming it 
in the pleistocene period that these elements are yet 
distinguishable by ethnologists. 

Q. Toward what does the American Indian lean 
in nose types? 

A. Its proto-caucasic, rather than its proto-mon- 
golic or proto-negroid elements. 

Q. How many types appear in Great Britain and 
Ireland? 

A. These types and traces of their blood are still 
detectable in living man. The neolithic race in Great 
Britain was dark, of feeble build, short stature, with 
dolichocephalic skulls. This race remained to the 
historic period as the Silures in Great Britain and 
the Firbolgs in Ireland. It had high cheek bones and 
oblique eyes. Toward the middle of the neolithic 
period this race was conquered by a brachycephalic, 
tall, long- armed, muscular race, with florid com- 
plexion and yellowish or red hair. The third race 
which invaded Great Britain was of fair complexion 
with prognathous jaws, dolichocephalic skull, of tall 
stature, great bones, great chest development, and 
massive jaws. 

O. Are there any pure races at the present time? 

A. As the intermingling of races began early, the 
question of the existence of pure races to-day, or even 
during the historic period, is an open one. 

Q. Are the Hebrews pure? 

A. They have been comparatively pure since the 
return from the captivity. Before that, as the history 



ON IRREGULARITIES OF THE TEETH. 131 

of Solomon's foreign marriages demonstrates, they 
were a raceless chaos, the Semitic element predom- 
inating. 

Q. Who were the Copts, or ancient Egyptians? 

A. They were a mixture of Turanian, Hamite, 
Aryan and Semite peoples" imposed on a negroid basis. 

Q. What occurred when these elements were 
finally fused? 

A. The race bred relatively true, although the 
lower classes tended to the negroid type and the 
higher to the Caucasic. 

Q. Of what do the Coreans consist? 

A. A mixture of two primitive races, one white, 
the other yellow. 

Q f . The Japanese? 

A. Their ancestors emigrated to Japan from Corea. 
They are products of the addition of two distinct types 
to that forming their Corean ancestors. The Polyne- 
sian, to a great extent, and the Malay, to a greater, are 
mixed with the original Corean. 

Q. The Chinese? 

A. The Chinese are neither a homogenous people 
nor a pure race, albeit the relatively few Mantchus 
are dominant, 

Q. The Indian Aryans? 

A. They are known to be, despite a rigid caste sys- 
tem, a non- Aryan race, feebly infused .with a modicum 
of Aryan blood. 

Q. What of the so-called "Gypsy?" 

A. The so-called "Gypsy" seems, of all the races of 
India, to have retained most Aryan speech and type 
as well as original Aryan semi-nomadic wagon- 
journeying in the midst of settled civilization. Ghetto 



132 QUIZ COMPEND 

seclusion long helped to preserve relative purity of 
race in the Jew, but despite vagabond surroundings, 
the "Gypsy" has remained even purer. 

Q. With the three races described as mingling in 
Great Britain and Ireland, has not even greater 
admixture occurred at a later period? 

A. Yes. The so-called Scotch-Irish (whose blood 
enters so largely in the dominant race of the United 
States), despite their speech (much more Teutonic 
and monosyllabic than English) are a raceless chaos 
of Gaelic and Cymric Celts, Lowland Scotch, French 
Huguenots, Danes (Celto-Teuto-Slavs), Palatinate 
Germans, Magyars, English Puritans, Hollanders, 
Swedes, Protestant Italians, Poles, and Spaniards. 

Q. How has a marked variation in type been pro- 
duced in the British Isles? 

A. The intermixture of the dark, small-boned, 
dolichocephalic, orthognathous (with-in-drawn jaws) 
race, with the brachycephalic, prognathous, big- 
boned, red-haired, and then with dolichocephalic, 
prognathous, deep-chested, big-boned, fair race, pro- 
duced in the British Isles as marked variations in type 
as now occur from the admixture of the Indian and 
the Negro. 

Q. What exerted a great influence in the British 
Isles? 

A. While religion played a part, war, commerce 
and art also exerted an influence. Thus Bunyan, the 
author of the "Pilgrim's Progress," was the descend- 
ant of Bunyano, an Italian architect, imported to 
build Melrose Abbey. The destruction of the Spanish 
Armada introduced Spanish elements all along the 
West and East coasts of England, Ireland and Scot- 



ON IRREGULARITIES OF THE TEETH. 133 

land. The capture of Calais by the French from Mary 
Tudor added a French colony to London. 

Q. What of the Scandinavian race? 

A. The primitive race called the Quens was of 
Esquimo type. This race was first intermixed with 
a tall, long-armed, brachycephalic, muscular race with 
florid complexion and yellowish or red hair. The race 
resultant on this mixture was later fused with a third 
having prognathic jaws, large dolichocephalic skulls, 
tall stature, great bones, great chest development, but 
small hands and high arched feet. After these race 
admixtures had formed the Scandinavians, who 
became the sea kings, the intermixture with other 
races still continued. Around Bergen, Norway, was 
an Irish colony with well formed, delicate features, 
brunette complexion, oblique blue eyes and black hair. 
The influence of this colony is still demonstrable. 

Q. What effect did these different types of skull 
and face have upon the English-speaking and Scandi- 
navian-speaking peoples? 

A. The contest for existence (between the organs 
of men) centered itself with peculiar intensity on 
structures which, like the jaws and teeth, are so vari- 
able with rise in the scale of evolution. 

Q. What would be the effect on the scion of an 
orthognathic mother and prognathic father? 

A. He would have marked irregularities of the jaws 
and teeth, destitute of the significance of the depth 
of degeneracy implied by the same irregularities in a 
purely prognathic or orthognathic race. 

Q. What caused an intense struggle for existence 
in such a mixed race? 

A. Food which exacted less active functions on the 



134 QUIZ COMPEND 

part of the jaws and teeth in such a mixed race would 
imply an intense struggle for existence between the 
different teeth, and this struggle would proceed 
with greater or lesser intensity as the organism was 
or was not affected by that constitutional nerve strain 
which precedes general degeneracy. 

Q. What effect do the different factors produce 
on the constitution? 

A. They create a general loss of nerve tone which 
relieves the local nerve systems of control by the cen- 
tral nerve system. 

Q. What becomes of these local nerve sys- 
tems? 

A. They take on feverish activity in consequence 
and become themselves exhausted. 

Q. In what way would this affect the jaws and 
teeth? 

A. In proportion, therefore, as the general nervous 
system has control would the evolution of the teeth 
and jaws, in their relation to the organ struggle for 
existence, proceed with regularity. 

Q. What influence would food have under these 
conditions? 

A. The influence of food, while beneficial to the 
organism as a whole, may, as already pointed out, 
introduce a struggle for existence between the teeth, 
causing local degenerations of these and the jaws. 

Q. If man used his jaws and teeth as a weapon of 
offense and defense, would the soft foods alone cause 
degeneracy? 

A. The employment of the teeth and jaws as 
weapons would prevent that degeneracy as a jaw 
otherwise consequent upon decreased use resultant on 



ON IRREGULARITIES OF THE TEETH. 135 

a change from vegetable and nut diet to the more 
easily digested and masticated meat or fish diet. 

Q. What indicates that such use of the jaw 
interfered with degeneracy? 

A. The persistence of prognathism in races as high 
as those described, even when brachycephalic, is an 
indication that the use of the jaw as a weapon inter- 
fered with its degeneracy consequent on improved 
food. 

Q. What does the vermiform appendix indicate? 

A. While man was a vegetable feeder, the atrophic 
tendency of the vermiform appendix shows that he 
early became a user of animal food, albeit not to the 
extent of carnivorous mammals, in whom the appendix 
has disappeared. 

Q. How did this change affect the jaws and teeth? 

A. This change initiated a tendency to variability 
in the jaws and teeth. 

Q. Are such changes demonstrable in America? 

A. This variability is excellently shown in four 
generations of so-called "Anglo-Saxon" Americans of 
the Knickerbocker type. The first is a probably 
neolithic Hollander type with low, receding negroid 
forehead, small, sunken eyes, protruding nose and 
upper lip, cheek bones prominent, receding lower 
jaw. The second was born of the previous type, 
settled in New York. The change in climate has 
altered the face considerably. The forehead is higher, 
broader and more prominent. The eyes are large and 
not so deeply set. The cheek bones are not so prom- 
inent, nose and upper jaw less prominent, upper lip 
longer, chin the same. Admixture of race types has 

produced a forehead broad and full, eyes less sunken, 
11 



136 QUIZ COMPEND 

recession of cheek bones, nose and tipper jaw; upper 
lip same ; lower jaw broader, anterior position same. 
Here the forehead is still broader, more prominent, 
higher; large round eyes. There is more recession 
of the cheek bones. The nose and upper jaw are the 
same. The face is broader, lower jaw broader and 
anterior position same. 

Q. Of what is this variability an expression? 

A. The law of economy of growth whereby an 
organ, under the influence of the struggle for existence, 
degenerates from the ideal type of the organ as an 
organ for the benefit of the organism as a whole. This 
variability along local lines of degeneracy seeks pecul- 
iarly the line of least resistance in the jaws and teeth. 

Q. What is the tendency in race admixture? 

A. The tendency in race admixture (when the new 
blood is of stocks with large jaws and regular teeth) 
is to stamp out local influences which tend to produce 
arrest of development and irregular teeth. By con- 
stant race admixture the jaws retain their normal reg- 
ular shape. The tendency of the child to inherit the 
small jaws of one and the large teeth of the other, or 
vice versa, is a fruitful source of facial and jaw 
deformity. 



CHAPTER XIV, 



CONSTITUTIONAL DISORDERS. 

Q. From what two standpoints must the influence 
of constitutional disorders on the development of the 
skull and face be viewed? 

A. First, from the standpoint of the mother af- 
fected during pregnancy ; and second, from the stand- 
point of the foetus affected during intra-uterine life, or 
of the child affected precedent to or during the periods 
of stress. 

Q. How may constitutional disorders, especially the 
infections, affect the mother? 

A. In the bony mal-development shown to occur in 
animals by Charrin and Gley, and in man by Coolidge. 

Q. Are facial bones jaws, and teeth peculiarly 
liable to this? 

A. They are. 

Q. What will be the effect upon the foetus, even if 
the disease in the parent be but temporary? 

A. Foetal development may be checked as to 
higher tendencies; thus mothers have borne moral 
imbeciles, epileptics, lunatics, or deformed children 
after a pregnancy during which they were attacked 
by contagious disease. The children of subsequent 
and previous pregnancies were normal. 

Q, What has been observed in regard to children 
before and after contagious diseases? 

A. The children of pregnancies previous to the one 
complicated by contagious disease may be healthy, 

137 



138 QUIZ COMPEND 

while those of subsequent pregnancies are defec- 
tive. 

Q. How may contagious and infectious diseases 
affect bodily strength? 

A. Any contagious and infectious disease may not 
only interfere temporarily with the bodily strength, 
but may produce complete change in the parent's 
system, extending even to the highest acquirement of 
man. 

Q. How are the nerve centers affected? 

A. The nerve centers controlling nutrition, growth, 
repair, secretion, and excretion are often as deeply 
affected as those checks constituting morality. At the 
periods of physiologic stress these effects are especially 
noticeable. 

Q. Specify them? 

A. Moral insanity, intellectual insanity, unequal 
mental balance, hysteria, precocious sexuality, uncon- 
scious mendacity, mental parasitism (the germ of pau- 
perism), epilepsy, neuroses, and all types of nutritive 
and constitutional defects result. 

O. Where may the nutritional defects appear? 

A. Chiefly in the walls of the blood vessels and 
lymphatics, as in scurvy, mercurial poisoning, etc. 

Q. While these occur in the chronic infections and 
contagions, where do they also result? 

A. In acute typhoid fever, scarlatina, diphtheria, 
whooping cough, etc. 

Q. How do these affect the blood? 

A, Proper blood supply, utilization and elimina- 
tion of waste are thus prevented. 

Q. Can organs then perform their functions? 

A. They cannot. They are predisposed to disease 



ON IRREGULARITIES OF THE TEETH. 139 

from disuse and from weakness of the disease-fighting 
phagocytes and antitoxins. 

Q. What results? 

A. Irregularity of organ functions, which is hered- 
itarily transmissible. 

O. What becomes of the weakened vessel-walls? 

A. They yield to strain, and thus produce local 
stomach, bowel, liver, gland, and kidney disorders. 

Q. Is this weakness completely transmissible? 

A. It alone may be transmissible to the offspring. 

Q. May the ductless glands be affected? 

A. The functions of the great ductless glands 
(thyroid, thymus, adrenals, pituitary body, bone- 
marrow, etc.), which secrete principles necessary to 
the equal balance of nutrition, are perverted. 

Q. What effect does perverted nutrition have upon 
the system? 

A. The liver in the acute, but more particularly in 
the chronic, contagions, paralyzed in nerve tone, fails 
in its functions, nutritive and poisoning-destroying, as 
for the same reason the kidneys fail in their power of 
ejecting hurtful waste. 

Q. What effect does nerve exhaustion have? 

A. Nerve exhaustion, with its suspicion, its capric- 
ious hopefulness and gaiety, is practically continuous in 
tuberculosis, syphilis, and leprosy. 

Q. How is the bony and dental development 
affected? 

A. In a general way the influence resembles that 
of syphilis. 

Q. How is this influence exerted? 

A. In two ways. First, on the individual, which 
may affect development of the bones or teeth if it 



140 QUIZ COMPEND 

occur during the periods of evolutionary stress. Syph- 
ilis contracted during infancy thus affects the develop- 
ment of the teeth. The same is true of all infectious 
diseases to a greater or lesser extent, and is likewise 
true of conditions like scurvy and rickets. In a gen- 
eral way also, the influence of the contagious diseases, 
as exerted on the descendants, is of two types. Firstly, 
the direct transmission of the disorder, which must be 
regarded as intra-uterine, and secondly, the transmis- 
sion from the ancestor to the descendant of sundry 
pathologic characters having nothing specific per se,but • 
consisting perchance in native inferiorities of constitu- 
tion, of temperament, of vital resistance, perchance in 
retardations, arrests, or imperfections of development, 
mental, physical, or manifested in organic changes; 
either malformations of organs or monstrosities. 

Q. What is the first of those heredities properly 
called? 

A. Syphilitic, typhoid, or small-pox heredity. 

Q. What is the second called? 

A. The second has received several synonymous 
titles; parasyphilitic (typhoid, etc.) heredity, dystro- 
phic heredity, or toxaemic heredity. 

Q. In the last the toxins produced by germs, or the 
poisons produced by maternal nutritional defects, cause 
what? 

A. The arrests, retardations, imperfections of 
development seen in the children of otherwise healthy 
mothers suffering from the infections and contagions, 
or from nutritional disorders or defects, just precedent 
to or during the period of pregnancy or during the 
period of lactation, 



ON IRREGULARITIES OF THE TEETH. 141 

Q. During the periods of stress what effect have 
these toxins or allied substances? 

A. They cause the bony and dental arrests, retard- 
ations, and imperfections of development so frequently 
noticed after scarlatina, pneumonia, cerebro-spinal 
meningitis, etc., as well as rickets and allied condi- 
tions occurring during infancy and childhood. 

Q. How are the regenerative processes affected? 

A. All the tissues are below par in constitutional 
diseases. Hence wounds dc not heal as readily in a 
person the subject of constitutional diseases. 

Q. What relation has embryonal tissue to repair? 

A. The development of tissue from an embryonal 
type to mature tissue is identical with the regenerative 
process in the healing of wounds. 

Q. How is the energy of the organism expended? 

A. In repelling the advances and barring the 
further progress of the micro-organisms or other 
causes of constitutional diseases. 

Q. What is the consequence? 

A. Warfare between the cells and microbes. The 
tissue cells that are regenerated do not increase the 
size of the organs as in normal development. 

Q. What do these constitutional diseases cause? 

A. Arrest of development which may become per- 
manent from the time of the disease. 

Q. What effect does this sometimes have upon the 
child? 

A. It stops development for one or more years, and 
frequently development will not proceed until the 
child is taken to another climate. 

Q. What effect does it have upon the jaws and 
teeth? 



142 QUIZ COMPEND 

A. Anomalies of the jaws and teeth result. When 
arrest of development of the teeth takes place, pits 
and furrows are often found in the enamel. 

Q. What do these pits and furrows indicate? 

A. The exact period when the arrest of develop- 
ment took place. 

Q. What kind of teeth especially result? 

A. Hutchinson's teeth. 

O. What effect do the eruptive fevers have upon 
children? 

A. They tend to leave the system in a neurotic con- 
dition. 

O. Do children always recover? 

A. Children who before were apparently healthy 
are after these diseases sickly and ailing for years, and 
sometimes never wholly recover. 

O. How are they affected? 

A. The eyes and ears and not infrequently the 
organs of speech are affected. The eyes remain weak, 
occasionally the patient becomes nearly or quite blind. 
The hearing is frequently permanently impaired; occa- 
sionally the nerve centers which preside over the 
development of the osseous system. There is a gen- 
eral arrest of development of the whole body. Such 
persons not infrequently remain sickly, neurotic, or 
morally imbecile. While they may regain liealth, the 
body ceases to develop normally. 

Q. Cite illustrations. 

A. A young girl, now twenty, born of apparently 
healthy parents, had a severe attack of scarlet fever 
at the age of seven years. Arrest of development of 
the upper jaw, and a V-shaped arch developed; she 
has been near-sighted ever since and now has very 



on Irregularities of the teeth. 143 

weak eyes; stopped growing for three years. She 
was taken to California and Europe and has now 
regained her full growth. A boy, now fourteen, had 
pneumonia at the age of four. Arrest of development 
of the bones of the face is very marked; he has 
stopped growing and is now very small for his age. 
A young lady, now twenty-three years of age, had 
scarlet fever at the age of four, with a resultant deaf- 
mutism. The bones of the face and jaws are undevel- 
oped. She possesses a marked V-shaped arch. The 
pits and grooves upon her teeth denote the age when 
she had the disease. She has developed into a very 
handsome, full grown woman. A lady, now forty- 
five years of age, had scarlet fever at three years. 
Her eyes became inflamed and she lost her sight for 
twenty-four years, when they gradually grew better. 
The bones of the face were arrested in development. 

Q. When may this arrest take place? 

A. At any period up to the time of full growth. 

O. When must arrest of the jaws take place to pro- 
duce dental deformities? 

A. Arrest of development of the jaws due to con- 
stitutional diseases must occur prior to the sixth 
year. 

Q. How is this modified? 

A. By the influence of the constitutional disorders 
of the hypophysis, which may lead to the excessive 
development of bony tissue anywhere, occur to an 
extreme extent in acromegaly, giantism, etc. 

Q. To what are arrests of development, charged to 
specific diseases, sometimes due? 

A. They are in reality due to toxaemic or nutri- 
tional causes. 



144 QUIZ COMPEND 

Q. To what Is the "old man" appearance of con- 
genital syphilis of the child due? 

A. It is due to arrest of development of the foetus 
at the A,y 2 month of intra-uterine life; the so-called 
senile period. 

Q May not this arrest of development be caused 
by conditions other than syphilis? 

A. Yes. 

Q. What other expression of degeneracy is partic- 
ularly apt to occur around the period of stress? 

A. That condition known as haemophilia, which is 
an hereditary constitutional defect evincing itself 
from deficient coagulability in a tendency to uncon- 
trollable bleeding, either spontaneously or from slight 
wounds. 

Q. What is it sometimes associated with? 

A. Sub-oxidization conditions like arthritis and 
lipomatosis. This diathesis has long been known. 

Q. What rule did Nasse give? 

A. As a rule the mother of the haemophile is not 
a "bleeder'' herself, but is the daughter of one. The 
daughters of a hsemophile, though healthy, transmit 
the diathesis to the male offspring. 

Q. When does haemophilia generally appear? 

A. After slight injuries during the period of the 
first dentition. 

Q. Give some illustrations. 

A. The Appleton Swain family of Reading, Mass., 
has had "bleeders'* for two centuries. Osier has 
reported instances in the seventh generation. Kolster, 
who has investigated haemophilia in women, reports 
a case in the daughter of a female haemophiliac. On 
his analysis of fifty genealogic trees of haemophiliac 



ON IRREGULARITIES OF THE TEETH. 145 

families, it is evident that Nasse's law of transmission 
is not absolute. In fourteen cases the transmission 
was direct from father to child and in eleven cases it 
was direct from mother to infant. 

Q. How are hemorrhagic symptoms of bleeders 
divided? 

A. Into exterior bleedings, either spontaneous or 
traumatic, interstitial bleedings, petechiae, ecchy- 
moses, and joint affections. External bleedings are 
seldom spontaneous, but generally follow cuts, bruises, 
scratches. 

Q. Are operations on bleeders dangerous? 

A. Yes. A minor operation may prove fatal. So 
slight an operation as extraction of a tooth has been 
followed by the most disastrous consequences. Gum 
lancing is equally dangerous. 

Q. What can be said of bleeding families? 

A. They are often multiparous, healthy looking 
and have fine skins. They are hence not suspected 
of " bleeding' ' tendencies by the practitioner who 
sees them for the first time. 



CHAPTER XV, 



INTELLECTUAL AND MORAL DEFECTS. 

Q. Upon what do most mental and moral defects 
depend? 

A. Upon brain malformation. There is a complete 
transition from the diencephalic monster, the micro- 
cephalous, the idiot, the imbecile, and the feeble- 
minded to the normal person. 

Q. What neurotics approximate the normal? 

A. Sentimentalists, pessimists, neurotics, hys- 
terics, neuropaths, epileptics, drug habitues, tramps, 
and prostitutes. 

Q, Are jaw and tooth defects found in these 
classes? 

A. Yes. Because of the struggle for existence 
between the brain and the face, defect is more or less 
shown in the face structures. 

Q. What expressions of defects are found in these 
classes? 

A. The prostitutes, while furnishing a larger pro^ 
portion, furnish the same types as all the other classes. 
In them skull types present deformities to the extent 
of 44% per cent. This is less than the percentage 
among idiots, but greater than the percentage among 
the other defective classes. There were 42% per 
cent, of face deformities, which would probably be the 
average of the other classes. There were 42 per cent. 
of the ear anomalies and 54 per cent, of tooth and 
jaw anomalies. As in the insane, idiots, criminals, 

147 



148 QUIZ COMPEND 

and hysterics, there was marked anomaly of the ex- 
ternal occipital protuberance. Among the abnormal 
skull types presented three were prominent. In the 
first the head was flattened at the vertex, the fore- 
head was hydrocephalic, the nose flat, and the lobe of 
the ear was much developed. In the second, the head 
was elevated at the vertex and the nose flat. In the 
third type the parietal region was asymmetrical. The 
anomalies of the face were marked asymmetry, sub- 
nasal prognathism, and disproportion of different parts. ■ 
There was deviation of the nose and deep excavation 
of its root. The nose, being often strongly flattened, 
the Gothic palatine vault occurred very frequently. 
There was frequently complete division of the palate. 
There were teeth defective, irregular in growth, riding 
over each other or widely separated. The teeth were 
often notched and grooved (Hutchinson's and Parrot's 
teeth). The teeth often encroached outside of the 
dental arch, the parabola of which was thus rendered 
irregular. There was atrophy or complete absence of 
the superior lateral incisor. 



CHAPTER XVI. 



INTER-OPERATION OF CAUSES AND PREDISPOSI- 
TIONS. 

Q. How do forces tending to changes in the organ- 
ism act? 

A. It will be. seen - that forces tending to changes in 
existing organism, act in various w r ays as part of the 
environment of the individual, and through its influ- 
ence on him produce changes in the complex union of 
checks, balances, forces, and material bases which con- 
stitutes the human organism as inherited. 

Q. What must any unusual change in complex 
unity be? 

A. Abnormal, so far as the organism existing prior 
to the change is concerned. The question whether 
such abnormality be of benefit or injury is another 
matter. 

Q. Why is it not necessarily evil? 

A. A metaplasia, a change from one species into 
another, whether in individual animals or plants or 
individuals or their tissues, cannot take place without 
an6maly, for if no anomaly appear this new departure 
is impossible. 

Q. Is the physiologic norm hitherto subsisting 
changed? 

A. Yes. This change cannot well be called any- 
thing but an anomaly. 

Q. What was an anomaly formerly called? 

A. It was called pathos, and in this sense every 
departure from the norm is a pathologic event. 

149 



150 QUIZ COMPEND 

Q. What must occur if such pathologic event be 
ascertained? 

A. This forces investigation as to what pathos 
was the special cause of it. 

Q. What may this change be? 

A. An external force or a chemical substance or a 
physical agent producing in the normal condition of 
the body a change, an anomaly (pathos). 

Q. What can this become? 

A. A foundation for certain slight hereditary 
characteristics propagated in a family. In themselves 
these belong' to pathology, even though they produce 
no injury. 

Q. What is disease in Greek? 

A. It is nosos, and it is nosology that is concerned 
with disease. . 

O. May the pathologic under some circumstances 
be beneficial? 

A. It may be of advantage to the inheritor. 

Q. What determines its character? 

A. It is obvious that the fact whether a given 
change in the organism shall prove a defect or not is 
determined by the conditions of periods of stress dur- 
ing intra- and extra-uterine life. 

Q. May defect so affect the organism as a whole 
as to survive the periods of stress? 

A. According to general observations this must 
be so. 

Q. What must be taken into consideration in deal- 
ing with the origin of any defect? 

A. In dealing with the origin of any defect or gain 
in the animal organism, several factors must be taken 



ON IRREGULARITIES OF THE TEETH. 151 

into account, independently of the simple element of 
heredity. 

Q. What is an uncomplicated agent? 

A. Heredity, which is usually regarded as produc- 
ing certain effects. 

Q. What must be considered in dealing with 
heredity? 

A. The influence of the intra-uterine stress of the 
foetus. 

Q. What effect will unusual strain upon the 
mother during gestation have? 

A. It may produce an unfavorable effect upon the 
foetus. 

Q. Does a healthy ancestry add any weight? 

A. The mother then would be less liable to ill 
effect from such a strain. 

Q. What effects do unusually favorable conditions 
produce during gestation? 

A. It may correct defects observable in previous 
pregnancies. 

Q. How are periods of stress constituted? 

A. By the different periods of embryonic develop- 
ment, as well as by those extra-uterine. 

Q. Can sex be determined by condition of stress 
after a certain period? . 

A. Yes. 

Q. What effect has nutrition? 

A. Poor maternal nutrition will determine an 
excess of males, while good will determine an excess 
of females. 

Q. What effect will arrest produce at certain 
periods of intra-uterine life? 

A. It will produce prematurely senile states; 



152 QUIZ COMPEND 

since, as already stated, there is a period in intra- 
uterine life during which the foetus wavers between 
the senile appearance of adult anthropoid apes and 
that of mankind in youth. 

Q. What may maternal nerve exhaustion do? 

A. General nervous exhaustion of the mother, first 
affecting checking influences of the central nervous 
system, finally leads to unchecked excessive nervous 
action of the part of the local nervous systems of the 
organs, leading secondarily to exhaustion of these. 

Q. What may result? 

A. In consequence the mother is unable to either 
manufacture proper elements of nutrition or to ex- 
crete waste material. 

Q. What effect does this have upon the foetus? 

A. The foetus, thereby starved and poisoned, fails 
to pass through the periods of stress in a complete, 
well-balanced manner. 

Q. On what structures does stress bear the 
strongest? 

A. Those which are transitory or variable in type. 

Q. What maternal influence may affect the foetus? 

A. Mental stress of the mother. The human 
foetus exhibits very decided reaction to sensory im- 
pressions on the mother. 

Q. What occurs at these periods of stress? 

A. The forces which determine the variations of 
the individual from the race, and those which tend to 
preserve the race type, are in constant conflict. 

Q. What determines whether or not the foetus 
shall pass through the complex embryologic evolution 
determined by the race type, and whether or not in- 
dividual variations presented in the parents shall be 



ON IRREGULARITIES OF THE TEETH. 153 

transmitted successively through these periods of 
stress? 

A. Conditions affecting nutrition of the ovum prior 
to fecundation (as derived from the mother), and con- 
ditions affecting the fecundation of the ovum (as 
derived from the father), as well as those derived from 
both father and mother after fecundation, will deter- 
mine whether or not the foetus shall pass through the 
complex embryologic evolution determined by the 
race type, and whether or not individual variation 
present in the parents shall be transmitted through 
these periods of stress. 

Q. What local conditions enter greatly into these 
factors as regards the jaw? 

A. While all the factors enumerated enter into jaw 
degeneration, a greater factor is extraction of the 
temporary and permanent teeth. 

Q. Is this extraction frequent? 

A. Yes. It is a universal habit abroad. 

Q. What effect does it produce? 

A. Constant extraction of the teeth produces varia- 
tions (arrests of development) which are transmitted 
from one generation to another. In the evolution of 
the jaws, nothing could be easier accomplished than 
this. One period of stress is marked by eruption of 
the temporary and the next period of stress by the 
eruption of the second set. The first permanent 
molar is the first tooth to erupt in the permanent set. 
It is situated in the center of the jaw. Permanent 
teeth erupt anteriorly and posteriorly to this tooth. 
This tooth, because it is larger, requires more room. 
The first molar is the first tooth to decay. As soon as 
it aches it is removed. When the other 'permanent 



154 QUIZ COMPEND 

teeth erupt they move forward and fill the space made 
vacant by the lost first molar. Since the jaw expands 
and grows for the purpose of containing the teeth, in 
their absence the jaw ceases to develop. What is true of 
the first molar is also true of the other teeth. In many 
countries one tooth after another is sacrificed as soon 
as it begins to ache. Not infrequently whole sets of 
teeth are removed in young life before the jaws have 
fully developed. The habit of early extraction of the 
temporary and permanent teeth from one generation 
to another causes arrest of development in two 
ways, 

Q. In what two ways does early extraction of the 
temporary teeth from one generation to another cause 
arrest of development? 

A. First, through the inheritance of acquired 
defects; second, by natural selection. Since the jaws 
and teeth are so unstable in their development they 
are easily affected. 

Q. What influence has civilization on the jaws and 
teeth? 

A. By its economy as regards food production and 
preparation it has lessened markedly the,function of 
the jaws and teeth. Food no longer needs the grind- 
ing and tearing required from primitive man, or even 
from types as high as the "pile dwellers," whose food 
is still to be found, even to coarse breads and cakes. 
Under the law of economy of growth, lessened mus- 
cular action leads to lessened blood supply. Lessened 
blood supply produces conditions in the offspring 
tending to under-nutrition of certain parts for the 
benefit of the body as a whole, and to diminish in size 
of unused .parts. As the jaws, alveolar process, and 



ON IRREGULARITIES OF THE TEETH. 155 

teeth are comparatively unstable in all mammals, 
these of necessity are peculiarly affected by disuse. 

Q. Is there a similar condition in the lower ani- 
mals? 

A. The dog, to whom domestication plays the part 
of civilization, has from a carnivore become an omni- 
vore. In the mongrel dogs, race admixture and other 
factors producing change in man are to be found. In 
the dog peculiarly, does domestication play the part of 
civilization. In him jaw and tooth irregularities 
ascribed to other causes occur. Facility for securing 
food under domestication has played a part. Disuse 
of the jaw as a weapon by man has done its share in 
the changes comparatively early in development. 
To a certain extent this last change is still going on in 
the dog. In cases predisposed to advance in evolu- 
tion, irregularities of beneficial type would occur 
with great facility. In cases predisposed in the 
opposite direction, changes would result of opposite 
effect. 

Q. Where are the fewest contracted jaws and 
irregularities of the teeth found in European count- 
ries? 

A. In Greece and Russia. 

Q. Where are the greatest number found? 

A. Among the English-speaking people and the 
Scandinavians. 

Q. Why? 

A. Both peoples have passed through very similar 
phases of race evolution and both contain at bottom 
the same race elements. 

Q. What is evident from this? 

A, That the struggle for existence between the 



156 



QUIZ COMPEND 



organs, dependent on race evolution and race admix- 
ture, has in the higher races resulted in the triumph 
of the brain and skull at the expense of the face, hence 
the higher the intellectuality the greater the tendency 
to local anomalies of the face, jaws, and teeth. 



CHAPTER XVII 



DEVELOPMENTAL NEUROSES OF THE FACE. 

O. Who was the first to study the face in a scien- 
tific manner? 

A. Camper, whose results gave his name to the 
facial angle by which is judged the rank of the face. 

Q. What is Camper's facial angle? 

A. A line drawn from the super-orbital ridge to a 
point at the nasal spine, and from this point to the 
auditory meatus. 

Q. What do the facial angles of Camper, Cuvier, 
Cloquets, Jacquarts, the Munich-Frankfort angle, and 
those of Topinard involve? 

A. Merely the bones of the head and face. 

Q. With what do most authors deal in discussing 
prognathism and orthognathism? 

A. With the skull, including only the superior 
maxilla. 

Q. What must medical specialists include? 

A. The inferior maxilla. 

Q. Why? 

A. Because only by the improved facial angle can 
correct bases be obtained upon which to compare 
deformities of the jaws. 

Q. Are there racial differences in the facial angle at 
the present time? 

A. There are. In the evolution of man every race 
may be included at some degree between the prog- 
nathous and orthognathous type of jaw. 

157 



158 QUIZ COMPEND 

Q. Is there a race type? 

A. Only in a general way. There may be cases of 
extreme protrusion and recession of jaws in each 
nationality, due to an unstable nervous system, a re- 
sult of excesses. 

Q. In the countries of Europe how do the jaws 
differ? 

A. In most countries the jaws are broad and pro- 
trude, while in some recession is the rule. 

Q. In what countries is orthognathism most com- 
mon? 

A. In Stockholm, Sweden, an examination of 
5,000 people showed the following results. A perpen- 
dicular line dropped from the supercilliary ridgs 
showed only 2 per cent outside, 14. 70 per cent, on 
the line and 83.00 inside the line or orthognathous. 
In London an examination of 10,000 revealed 4.13 per 
cent, outside the line, 12.87 on the line and 83.00 
inside the line. In an examination of 3,000 English 
school children (about ten years of age) 93 per cent 
possessed jaws inside of the line. Prognathism as a 
rule was a prominent feature in other nationalities. 

Q. What significance has this? 

A. In a general way it is possible to decide, with- 
out an examination of the mouth, the frequency of 
irregularities of the teeth; when prognathism is 
present there is plenty of room for the teeth, and vice 
versa. 

Q. Is there not a quicker and easier way to arrive 
at this result? 

A. There is. The evolution of the American 
negro is an apt and striking illustration. 

Q. Give examples. 



ON IRREGULARITIES OF THE TEETH. 159 

A. Dr. W. E. Walker made an examination of 357 
of the lowest negro type in New Orleans. His results 
were protrusion in 97.5 per cent., on the line 2.5. 
Those made in Baltimore show 8 per cent, outside 
the line, 36.5 on the line, 55.5 inside. Those made 
in Philadelphia, 6S6 in all, 83.57 outside, 15.95 on the 
line, and 1.13 inside. In Boston, of 1,000, 45.5 outside 
the line, 39.5 on the line, 15. 1 receding. In Chicago, 
of 1,085, 51.06 presented protrusion, 31.08 on the line, 
and 16.6 inside the line. It will be seen, therefore, 
although the negro is from a marked dolichocephalic 
race with excessively protruding jaws, climate, soil, 
and intermixture have made a wonderful change in 
a very few years. 

Q. How does the change in the jaws compare with 
that of the teeth? 

A. Evolution of the teeth is a much slower process. 
The teeth do not grow smaller in proportion to the 
jaws. 

Q. How does the evolution of the jaws compare 
with the weight? 

A. In the same proportion. Ward has shown by 
weight that absolute size of the lower jaw is greater in 
primitive races. Of nine aborigines the mean weight of 
the jaw was 102.4 grams. Of eighteen white males the 
mean weight of the jaw was only 83.4 grams. Yet 
the weight of the skull was nearly alike in both cases. 

Q. What is the weight of the lower jaw compared 
with that of the cranium? 

A. It is 15.6 from aboriginal man as against 12.16 
from white men. It is 46. 2 from anthropoid apes. 

Q. What does this prove? 

A. It proves a progressive degeneracy in the jaws. 

Id 



160 QUIZ COMPEND 

Q. Are changes taking place in the shape of the 
head? 

A. Yes. An examination of eighteen negroes taken 
at random revealed five with a cephalic index below 
seventy, six between seventy and eighty, and seven 
about eighty. In an examination of 2,000 negroes 
in Chicago only six dolichocephales were found. 

Q. What do these figures indicate? 

A. They show that, allowing for slight admixture 
of brachycephaly from the negro race themselves, 
change in climate and admixture of Indian and fcau- 
casic races in America have completely changed the 
shape and physique of the negro. 

Q. What characteristic feature has a tendency to 
increase prognathism? 

A. The excessive development of the inferior 
maxilla. The rami and body of the lower jaws, 
together with the muscles of mastication, are very 
large and massive ' as compared with those of the 
white. The constant force of the larger lower jaw 
against the light upper causes the teeth and alveolar 
process to be carried forward, producing prognathism. 

Q. How do the jaws of the negroes living in the 
Northern states compare with those of the whites? 

A. Their jaws are not unlike those of the Caucasic 
races. The zygomatic arches are smaller. The 
muscles are less dense and rigid, the lower jaws less 
massive, and orthognathism in lieu of prognathism 
occurs to a certain extent. 

Q, What do degeneracies imply? 

A. Deficiencies in constitution, not only mental and 
moral, but neurosal and structural. 

Q. How do these deficiencies manifest themselves? 



ON iR'REGULARITIES OF THE TEETH. 161 

A. By expression of imperfect advance, evincing 
itself in the unequal balance between hypertrophy, 
excessive development, statu quo, and atrophy. 

Q. Which structures of the body are more liable 
to become affected than others? 

A. Transitory structures. 

Q. Name some of them. 

A. The vermiform appendix, the ears, the head, 
face, jaws, and teeth. 



CHAPTER XVIIL 



DEVELOPMENTAL NEUROSES OF THE NOSE AND 
INTERIOR FACIAL BONES. 

Q. Does the embryonic development of the bones 
of the nose and internal facial bones differ from that 
of other structures of the head and face? 

A. No. The interior bones of the face are as tran- 
sitory in their nature and development as the jaws and 
teeth. 

Q. Are deformities of the vomer, turbinated bones, 
and the maxillary sinuses associated with other de- 
formities of the face and jaws? 

A. Nearly always. Deformities of the internal 
bones of the face may occur, however, without face and 
jaw deformities, and vice versa. 

Q. What is the frequency of vomer deformities? 

A. Theile found the septum normally placed in 
twenty-nine out of 117 skulls. Semeleder examined 
forty-nine skulls and found deflection to the left in 
twenty, to the right in fifteen, and sigmoid deformity 
in four. Harrison Allen in fifty-eight skulls found 
narrowing to the left nineteen, to the right twenty- 
one. 

Q. Are dry skulls available according to Zucker- 
kandl? 

A. Dry skulls do not accurately illustrate the con- 
dition of the septum. 

Q. What were Zuckerkandl's results from re- 
searches on the cadaver? 

163 



164 QUIZ COMPEND 

A. Out of 370 he found 123 symmetrical and 140 
asymmetrical. In the deformed specimens the 
septum was inclined to the right in fifty-seven cases, 
to the left in fifty-one, sigmoid in thirty-two. 

Q. What results had Mackenzie? 

A. He examined 2,152 skulls in the museum of the 
Royal College of Surgeons, London, He found 1,657 
deformed septa, 834 deflected to the left, 609 to the 
right. In 205 the deflection was sigmoid, while in 
five the irregularity was zigzag, showing 70 per 
cent, of deformities in the dry skulls, and only 40 
in the cadaver. 

Q. What did Heyman's examination %how? 

A. Ninety-nine per cent, of deformities in living 
subjects. 

Q. How do these compare as regards races? 

A. Zuckerkandl found in 103 cases of primitive 
and semi-primitive races twenty-four were asymmet- 
rical. Mackenzie in 430 skulls of superior races 22.0 
percent, of deformities. He confirms the observa- 
tions of Zuckerkandl. 

Q. What are Harrison Allen's observations? 

A. He found in ninety-three negro skulls deform- 
ities of the septum in 21.5 per cent. 

Q. What are the results of Talbot's researches? 

A. He examined 11,000 skulls in this country and 
Europe, including the collection in the museum of 
the Royal College of Surgeons, and 347 living individ- 
uals. He confirms the report of Mackenzie. Owing 
to the fragility of the septum the whole or anterior 
part was lost in 3,400 skulls. Of the 7,600 skulls, 
5,762 showed marked deformities. Out of 687 ancient 
Peruvian skulls, 147 possessed deflection of the sep- 



ON IRREGULARITIES OF THE TEETH. 165 

turn. In sixty-nine Stone Grave Indians thirty-five 
were normal, thirty-four deformed. In eighteen 
Mound Builders, eight were normal and ten deformed. 
In six California Indians four were normal. In 
twenty-eight skulls of ancient Hawaiians deflection of 
the septum was noticed in twenty-three cases. 

Q. Were other deformities noticed in Hawaiian 
skulls? 

A. Yes. In two cases where the inferior turbinate 
bones were undeveloped the septum deflected to that 
side. There were projections which seemed to take 
the place of the missing turbinates. 

Q. What was the condition of the vomer in living 
persons? 

A. One hundred and seven showed deflection of the 
septum. 

Q. Does Zuckerkandl's theory that dried specimens 
are unsatisfactory in studying deformities of the sep- 
tum hold true? 

A. It does not seem plausible, for the reason that 
the two points of attachment are fixed at puberty. 
The septum, green or dry, cannot change its position ; in 
the dry the deformity may not be quite as marked. 

Q. Is not deflection of the septum in the living 
subject or the cadaver more difficult to diagnose than 
in the dry skull? 

A. Certainly. . This no doubt accounts for the 
small percentages of deformities reported by Zucker- 
kandl and Talbot. 

Q. Are there not deflections in the posterior nacres 
that are difficult to discover? 

A. Yes. Deflections in the middle and posterior 
nares are quite difficult to detect. 



166 QUIZ COMPEND 

Q. What shapes do these deformities usually take? 

A. The sigmoid (S-shaped), again like the letter 
C, and often like the small italic letter/ The fact 
that it is attached throughout at its upper and lower 
border to a solid framework, its middle portion is 
liable to bend in any direction like a loose sail in the 
wind. 

Q. May septum fracture be easily differentiated 
from deflection? 

A. Yes. 

Q. What are some of the theories as to the cause 
of deformities? 

A. The use of astringents was one of the older 
theories. Morgagni's was that they were due to 
excessive development of the vomer. Trendelenburg 
believed they were due to crowding up of a high 
arched palate, since the two conditions are frequently 
connected. Jarvis having seen four cases in the same 
family believed it due to direct heredity. Schaus and 
Walker believed it due to faulty development of 
the facial skeleton. Bosworth believed it due to 
traumatism. 

Q. Is it possible for traumatism and low forms of 
inflammation to produce all, or nearly all, of these 
deformities? 

A. It does not seem possible. If, however, by 
traumatism is meant inhalation of air, this would 
account for fracture. 

Q. What proportion of those examined seem to be 
fractures? 

A. Of the entire number examined, 2,684 appeared 
to be fractures. 

Q. Where were these fractures located? 



ON IRREGULARITIES OF THE TEETH. 167 

A. Most were at the middle, while some were at the 
posterior part to the vomer. This fracture or rough- 
ening was always in the convex surface of the bend. 

Q. How was this repaired? 

A. Frequently ribs of bone would be thrown out 
to support this curvature. 

Q. Could a blow reach the point? 

A. No. Most of them were located from .75 to 
two inches inside the nose from the nasal spine. 

Q. Does the inflammatory theory seem logical? 

A. No. The inflammatory condition must extend 
upon both sides, since the bone (should one be present) 
is very thin. 

Q. How about a high, contracted vault forcing the 
septum out of place? 

A. While high vaults and deflected septums most 
always go hand in hand, it is impossible for the vault 
to be carried upwards owing to the strong support of 
the nasal bone. The vault is developed downwards, 
not upwards. 

Q. Would not the suture assist in preventing the 
vault being carried up? 

A. Most certainly. The suture at the median line 
is like the keel of a ship, only upside down. 

Q. At what period does the vault obtain its shape? 

A. Not until after the sixth year. The high vault 
is never seen before that time, since it forms with the 
second se* of teeth. 

Q. Are deflected septa found at that period? 

A. A large majority of cases are found to com- 
mence to form before that time. 

Q. Could the vomer pull up or push down the 
vault? 



168 QUIZ COMPEND 

A. No. In either case the vomer would become 
taut. 

Q. It has been claimed the ridge frequently found 
in the roof of the mouth is due to the downward 
movement of the vomer. 

A. In an examination of 1,367 skulls in which this 
was partially or fully developed, a corresponding 
depression could not be found in the floor of the nose. 

Q. What is the relation between deflected septa and 
high vaults? 

A. All who have made investigation have shown 
that deflected septa are common among early and 
relatively pure races. High vaults and contracted 
arches are never seen in such people. 

Q. What is the most plausible theory? 

A. That advanced by Morgagni, that the septum 
has developed beyond normal, and in order to accom- 
modate itself it must deflect to the right and left. 

Q. Would not obstruction to the nose assist in 
developing the vomer? 

A. Yes. The inhalation of air would cause a 
vacuum, drawing the bone in and causing it to develop 
in either direction. 

Q. Are not the turbinated bones often either ex- 
cessively developed or arrested? 

A. Yes. The inferior turbinates are rarely if ever 
normal. Sometimes they are so large as to fill the 
lower part of the nose, again they are not developed. 
Again one side will be hypertrophied, the other 
arrested. 

Q. When asymmetry of the skull and face are 
observed are stigmata apt to be found in the nasal 
bone? 



ON IRREGULARITIES OF THE TEETH. 169 

A. Yes. Almost invariably. The two sides of the 
face are unlike, one orbit may be smaller than the 
other and one maxillary bone contain a smaller 
antrum than the other side. 

Q. Will arrest of development of one side cause the 
teeth to be forced out of the arch? 

A. Yes, and the roots of the teeth in many cases 
protrude through the outer piate of the alveolar pro- 
cess. 

Q. Are the mastoid processes involved? 

A. One or both may be excessively developed or 
arrested. 

Q. When the turbinated bones are excessively 
developed or arrested, what position does the vomer 
assume? 

A. It usually takes the curve of the turbinates so 
that it will stand about midway in all directions. 

Q. Are the nasal cavities often arrested? 

A. The nasal cavities are sometimes arrested 
with hypertrophy of the turbinates, deflection of the 
septum, and hypertrophy of the mucous membrane, 
preventing the child from breathing through the nose. 

Q. Does not arrest of the nasal cavities mean 
arrest of the superior maxilla and vice versa? 

A. When one is involved the other is also apt 
to be. 

Q. Is it common to find arrest of development of 
the inferior turbinate bone in ancient skulls? 

A. Yes, It is quite common in Alaskan races and 
Peruvian skulls. 

Q. What other stigmata may be seen in connection 
with the nasal cavities? 

A. Occasionally one nasal cavity will be lower than 



170 QUIZ COMPEND. 

the other, again both cavities may be carried over to 
one side. 

Q. With such deformities of the bones of the nose 
and maxilla, there must be marked deformities in the 
antra. 

A. Such is the case. Sometimes the internal bones 
of the face will be deformed to the extent that a very 
large antrum will develop upon one side and none 
upon the other. Again, one side will be made up of 
eight or more small cavities like the ethmoidal cells, 
while the antrum upon the other side will be large. 

Q. Does this make it difficult to enter the antrum 
by carrying a drill up through the alveoli? 

A This is very unsafe procedure. Operators have 
often carried the drill into the floor of the nose. 

Q. Are projections or spurs often found in the 
nose? 

A. They are very common. They may be situated 
at almost any locality, but seem to be found at any 
point where there is considerable space. 

Q. What is the most common location for them? 

A. Upon the vomer, projecting midway between 
the turbinated bones. 

Q. What is the width of the external nasal cavity? 

A. It varies greatly. In 2,000 skulls the greatest 
width was 1.25 inches, the smallest was .75. The 
length from the nasal spine to the outer border, greatest 
width 1.54, smallest 1.20. These skulls, however, were 
those of Peruvian Stone Grave Indians, Mound 
Builders, Cliff-Dwellers, Hawaiians, etc. In neurotics 
and degenerates, where arrest of development of the 
face and nose takes place, the width measured .50 to 
.60 inches, .80 to .90 of an inch in length. 



ON IRREGULARITIES OF THE TEETH. 171 

Q. If both sides be not alike, will there be free 
circulation? 

A. "No. If one side is filled with excessively devel- 
oped bones, the other side will have to take air enough 
to supply the required amount. This will cause the 
open side to enlarge. 

Q. What were Ziem's experiments? 

A. He showed that if one nostril of a rabbit be per- 
manently closed, and the animal killed, when it had 
attained its full growth, the nasal cavity of the affected 
side will be found to be undeveloped, and face asym- 
metry occur. 

Q. What was the condition of the opposite side? 

A. The air passages in the opposite side were en- 
larged. 

Q. What effect does a greater quantity of air have 
upon the developed side? 

A. The turbinates enlarge, owing to the stimula- 
tion, and the vomer is carried to the weaker side. 

Q. Does the septum ossify as early as the other 
bones of the nose? 

A. It does not, and therefore it is more easily 
moved out of normal position. 

Q. At what period does this occur? 

A. At or about the sixth year. 

Q. Are these bones vascular? 

A. They are. 

Q. For what reason? 

A. For the purpose of warming the air before it is 
taken into the lungs. 

Q. Owing to this vascularity are they more liable 
to excessive development? 

A. They are. The turbinates being exceedingly 



172 QUIZ COMPEND. 

unstable, with considerable vascularity, the slightest 
stimulation causes them to develop. 

Q. Does the condition of the turbinates determine 
the future shape of the vomer? 

A. Yes. These develop first and the vomer ossify- 
ing last is molded into position by inhalation and exhal- 
ation of air as nearly as possible into two equal cavities. 

Q. Are both sides always equal? 

A. Not always; owing to inflammation of the 
mucous membrane of one or both sides, due ta colds 
and other causes, one side will become filled up. This 
not infrequently causes the vomer to become attached 
to the turbinates. 

Q. In what class of patients do these conditions 
usually occur? 

A. In neurotics and degenerates, since tissue build- 
ing is very unstable. 

Q. Is it in them that atrophy, hypertrophy, and 
adenoid growths usually occur? 

A. Yes. Arrest of development of the face, includ- 
ing the upper jaw and bones of the nose, first takes 
place, the nose fills up on account of the arrest, and 
hypertrophy of the bones of the nose results, filling 
the nasal cavities, the result of which mouth-breathing 
takes place. 

Q. Is nasal catarrh associated with such cases? 

A. It almost always occurs in such unstable condi- 
tions. 

Q. What is the general appearance of the nose? 

A. In neurotics and degenerates the face is arrested 
from the supercilliary ridges down to and including 
the teeth of the upper jaw. It has a hollowed-out 
appearance. The nose is long and thin. 



ON IRREGULARITIES OF THE TEETH. 173 

Q. Does inhalation interfere in such cases? 

A. Very markedly. When the person inhales air 
the sides of the nose close like a bellows, causing the 
person to breath through the mouth. 

Q. What peculiar characteristic is nearly always 
noticed in persons who possess arrest of the nose and 
face? 

A. Arrest of chest walls and lung tissue almost 
always takes place. 

Q. What significance has this? 

A. Such people are liable to become infected with 
tubercle bacilli, because of mouth-breathing; the germs 
are taken into the mouth and are easily passed into 
the undeveloped lungs. 

Q. What precaution should be taken in such 
children? 

A. Children who have arrest of nose, face, jaws 
and chest walls should live out of doors as much as 
possible, eat nutritious food, and have the best of 
hygienic attention. 

Q. What is the antrum? 

A. It is a cavity situated upon either side in the 
superior maxillary bone. 

Q. Describe it. 

A. Gray speaks of it as being a large triangular- 
shaped cavity; its apex, directed outward, is formed by 
the malar process; its base by the outer wall of the 
nose. This description does not hold good in all cases, 
since the antrum (which depends on variation in evo- 
lution of the face, and further variation dependent on 
the nature of the transitory structure with which it is 
connected, as well as on the periods of evolutionary 
stress) must be entirely variable. It is hence not 



174 QUIZ COM?£ND 

surprising that the variability of the antrum cannot be 
overestimated. 

Q. What may be said of it in a general way? 

A. That the height, length, width, and location are 
governed by the shape of the face, and by the type of 
the nose, and of the superior maxilla. The shape and 
position, therefore, vary wideJy. 

Q. Describe some of these. 

A. One may be very small and resemble a crescent 
with the concavity toward the nasal wall, its convexity 
toward the malar process. It may not be large enough 
to admit the end of the little finger, and may not 
extend laterally to the inferior orbital opening. 
Sometimes the antrum upon one side will be very 
long, while upon the other it is very short and small. 
Usually the nasal cavity will be carried over nearly 
one-half its size to the side of the smallest antrum. 

Q. Is it not sometimes almost obliterated? 

A. Occasionally the locality of the antrum will be 
filled with soft cancellated bone, again it will be 
divided into small cavities, with cancellated bone 
between them. These resemble the ethmoidal cells. 

Q. In most cases what shape does the antrum 
assume? 

A. Although the antrum is usually regarded as a 
triangle, it assumes even in normal subjects a great 
variety of shapes. In degenerates, therefore, a 
greater variety of shapes and positions are assumed. 

Q. Should great care be exercised in making open- 
ings into the antrum in operations? 

A. Yes. The cavity is sometimes situated entirely 
outside of the alveolar ridge. In such cases the floor 
of the nose is usually over* the alveolar process. A 



ON IRREGULARITIES OF THE TEETH. 175 

drill passing through the alveolar process would enter 
the floor of the nose. In some cases the antrum is so 
large that it extends from about midway the face, 
including the inner surface of the malar process, with 
a very thin wall for the floor of the orbit. In drilling 
an opening through the alveolar process care should 
be exercised not to allow it to pass through the floor 
into the orbital cavity. 

Q. Is it not possible for the antrum to become 
obliterated with such malformations? 

A. When the cavity is extremely large upon one 
side the chances are that it is very small, or nearly or 
quite obliterated, in the other side. In such cases a 
drill would not reach it when passed through the 
alveolar process. 

Q. In these cases was the antrum clear and free of 
all obstruction? 

A. In 963 cases septal projections were found rang- 
ing all the way from simple ridges to partitions extend- 
ing two-thirds the height of the cavity; again several 
septa or partitions could be seen dividing the cavity 
into many smaller ones. 

Q. Did they completely separate the cavity? 

A. In no -case was the cavity entirely separated. 

Q. Do the roots of the teeth ever penetrate the 
antrum? 

A. In an examination of 11,000 skulls, 3,000 were 
broken so that the antra could be examined, making 
6,000 antra in all. Of this number 1,274, or about 
twenty-one per cent., had abscessed teeth ; of this num- 
ber seventy-six, or about six per cent., extended into 
and discharged into the antrum. Dr. M. H. Fletcher, 
of Cincinnati, examined 500 skulls, making 1,000 



176 QUIZ COMPEND 

antra, with the following results : Two hundred and 
fifty-two upper molars were abscessed, making twenty- 
five per cent, in the locality of the antrum. In these, 
abscesses in the antrum were found twelve times, or 
one in every twenty-one. 

Q, Are many cases of diseased antrum due to 
abscessed teeth found? 

A. In a thirty years' practice, 367 cases of pulpless 
molars (less than one per cent.) were found. In 224 
cases of pulpless molars, Dr. M. H. Fletcher fpund 
only one case of pus in the antrum. Dr. Bonwill had 
never seen a case in his practi#e. Antral disease is 
very rarely the result of abscessed teeth. 



CHAPTER XIX. 



DEVELOPMENTAL NEUROSES OF THE EYE. 

Q. Are the eyes in the embryo larger than in the 
adult? 

A. They are. They resemble the eyes of the 
lemurs, thus retaining an embryonic tendency. 

Q. Are the large orbits liable to remain? 

A. Embryonic large sockets may remain, or they 
may pass through the lemurian stage, to reach and 
even exceed the anthropoidia in smallness and close- 
ness together. 

Q. Do the eyes, like other structures, embryon- 
ically pass through the different zoologic phases? 

A. The eyes, like the brain and other structures of 
the body, pass through the different vertebrate stages 
of development. 

Q. What causes these changes? 

A. If growth be interfered with by the law of econ- 
omy of growth, the eye assumes lower forms, as in 
persistent hyaloid, colobomata, microphthalmia, etc. 

Q. Do these structures resemble exactly those of 
the lower animals? 

A. Neither the degenerate human brain nor the 
undeveloped eye resemble exactly the brain or eye of 
the lower animals. 

Q. What are the views as to the primitive eye type 
of the vertebrates? 

A. There are two claims, one that the eyes were 
derived from the median eye of the ascidian lancelet, 

177 



178 QUIZ COMPEND 

the other that existing vertebrate eyes represent the 
paired eyes of a hypothetic annelid precursor. Both 
views are reconcilable through study of the ascidian 
and lancelet eye collated with cyclopian and trioph- 
thalmic (three-eyed) degeneracies in man, the human 
eye and the third eye of reptiles, like the hatteria of 
New Zealand. 

Q. Does the eye of the ascidian tadpole agree fun- 
damentally with the type of eye peculiar to the verte- 
brates? 

A. Yes, in that the retina is derived from the 
wall of the brain. On this account it is called a myo- 
lonic eye. 

Q. How does the typical invertebrate eye differ? 

A. The retinal cells are differentiated from the 
external ectoderm. 

Q. How does the ascidian eye differ essentially 
from the paired eyes of the skulled vertebrates? 

A. In that the lens, as well as the retina, is derived 
from the wall of the brain. 

Q. How is the lens of the lateral eye of the verte- 
brates derived? 

A. From an invagination of the ectoderm, which 
meets and fits in the retinal cup of the end of the 
optic vesicle. 

Q. How does the ascidian eye, as to lens origin, 
agree with the parietal or pineal eye of the lizard? 

A. The lens is likewise derived from cells which 
form part of the wall of the cerebral outgrowth that 
gives rise to the pineal body. 

Q. What is the pineal body? 

A. It is a remarkable rudimentary structure, whose 
constant presence in all groups of vertebrates forms 



ON IRREGULARITIES OF THE TEETH. 179 

such an eminently characteristic median outgrowth 
from the dorsal wall of the brain (thalamencephalon). 
The distal extremity of this dilates into a vesicle and 
becomes separated from the proximal portion. 

Q. What becomes of the distal vesicle? 

A. It becomes entirely constricted off from the 
primary epiphysial (pineal) outgrowth of the brain, 
and the parietal nerve does not represent the primitive 
connection of the pineal eye with the roof of the brain, 
but arises quite independently of the proximal portion 
of the epiphysis. 

Q. What did the remote ancestors of the verte- 
brates possess? 

A. A median unpaired myolonic eye, which was 
subsequently replaced in functon by the evolution of 
the paired eyes. 

Q. Do cyclopic conditions occur frequently? 

A. Yes. More frequently among human mon- 
strosities than among animals. 

Q. Why? 

A. This is due to the fact that human monstrosities 
are much more frequently recorded. Of the 120 cases 
of human cyclopia fifty-six presented other evidences 
of degeneracy than cyclopic conditions, and sixty had 
neuropathies or other taint in the ancestry. 

Q. How is a cyclops produced? 

A. Production of a single eye, the changes in the 
structure of the mouth, the strophy and abnormal 
situation of the olfactory apparatus and of the vesicle 
of the hemispheres, all result from arrest of develop- 
ment, as Dareste has shown. The determining influ- 
ences must be exerted very early in the life history of 
the embryo. 



180 QUIZ COMPEND 

Q. Cite instances of cyclops. 

A. A female, born alive, to a negro multipara, 
which died two hours after birth. The eye was cen- 
trally located in the forehead on a line with the nose. 
The brow was a complete arch, as was the upper 
eyelid. The lower lid had a mark midway, indicating 
an attempt at division. The nasal bones were want- 
ing. The soft part of the nose, destitute of the orifice, 
hung over the mouth, which was completely covered. 
The chin was recedent. In another case the nose was 
wanting. Its place in the median line was occupied 
by a single eye; on the horizontal diameter were two 
pupils separated by a narrow space. 

Q. What does Landolt claim? 

A. Discussing a case by Valude, he claims that 
while in cyclopic eyes all the parts may be doubled 
or unite in every degree, there is never a single lens 
or double vitreous. 

Q. Is this borne out by other cases? 

A. Bock describes cases in which the eye had not 
been formed by the conglomeration of two separately 
developed eyes, but is a single developed eye; the 
other being wanting entirely. A cyclops, in which 
there was a single socket for the eye, of a lozenge- 
shape, situated in the lower middle of the forehead. 
The socket was furnished with two pairs of eyelids, 
upper and lower. The eye was found to consist of 
two rudimentary retinae, apparently springing from a 
single optic vesicle. The nose was represented by a 
short process, attached to the forehead, above the 
median eye. 

Q. What dental deformities may a cyclops present? 

A. In a cyclops, born living, but killed by pressure 



ON IRREGULARITIES OF THE TEETH. 181 

on the funis, the month contained an ivory tusk-like 
tooth at each corner. There was mane-like hair around 
the neck. 

Q. What accompanies cyclopia? 

A. Absence of both the internal and external ear, 
and synotia (joined ears). In the triophthalmic cases 
the three eyes are usually separate ; two occupying the 
usual position, while the third is situated in the center 
of the forehead. 

Q. How many cyclops did ninety families of degen- 
erates average? 

A. In an average of eleven children each, there 
were five cyclops. 

Q. How does degeneracy affect the eye? 

A. Degeneracy, which affects so deeply the devel- 
opment of the eye, naturally tends to evince itself in 
other anomalous states in the organ. As excessive 
asymmetry of the body is one of the most noticeable 
of the stigmata of degeneracy, it is not astonishing to 
find that this asymmetry expresses itself both in the 
position as well as in the size and structure of the eye. 
Asymmetrical irides are exceedingly frequent in the 
types of insanity due to hereditary defect. 

Q. What other anomalies are found in the eyes of 
degenerates? 

A. The conditions of the eye, known as microph- 
thalmia (small eyes), macrophthalmia (big eyes), and 
anophthalmia (absence of eyes), are found quite fre- 
quently in degenerate families. Corectopia (displace- 
ment of the pupil so that it is not in the center of the 
iris) often exists. Coloboma (eye fissure) is also not 
infrequent among degenerates. 

Q. How do these vary? 



182 QUIZ COMPEND 

A. These vary greatly in situation and general 
results. The iris is sometimes completely absent on 
one or both sides (aniridia). Beside these anomalies, 
morbid conditions, like retinis pigmentosa, congenital 
cataract, and macular degeneracy are far from infre- 
quent expressions of degenerate taint of the eye. The 
organ in this particular obeys the general law that 
degeneracy may show itself in the minute change, 
resulting in disturbances of functions or that produc- 
ing disease or finally atavism. The defects of the eye 
requiring glasses are exceedingly frequent in degen- 
erates and aggravate their morbidity. 

Q. Cite instances of eye degeneracy. 

A. Female, age fourteen. Patient's people are 
exceedingly poor and so ignorant as to make it impos- 
sible to get any reliable family history. There are 
four sisters and three brothers, all poor and ignorant. 
The patient is idiotic. She has a retreating forehead 
and exceedingly crooked nose, a very long, thin 
neck, and an exceedingly small, retrusive jaw, the 
lower incisors striking at least one-half inch behind 
the upper. The teeth are exceedingly irregular. The 
two left upper incisors are large, the two others very 
small. Of the lower incisors, the two central ones 
are like mice teeth, pointed and sharp. They are 
separated at their bases, but come together at their 
tops, at an acute angle. The other two are conical and 
lie each parallel to its neighbor. Examination of 
eyes reveals V— fingers in one-half M. Eyes small. 
Nystagmus. Fundi apparently normal. Diagnosis, 
microphthalmus. 

Female, age seventeen. Father is deaf. Could 
obtain no history of degenerate stigmata in mother. 



ON IRREGULARITIES OF THE TEETH 183 

Has four sisters living, nine dead. Has four brothers 
living and one dead. Had to depend on patient for 
family history. The patient is exceedingly dull. It 
is impossible for her to learn. She has jaws that, at 
the junction of the premaxillary and maxillary bones, 
present a well marked angle. Her teeth are conical. 
The incisors are sharp and pointed; are like mice teeth. 
The ears are small, and placed high upon the head; 
she is an almost typical degenerate, both physically and 
mentally. Examination of the eyes reveals V — can- 
not count fingers, but sees large objects. 



CHAPTER XX. 



DEVELOPMENTAL NEUROSES OF THE BONES OF 

THE EAR. 

Q. Are ear deformities frequently found? 

A. They are very common. Total absence of the 
external as well as embryonic internal ear occurs. 

Q. Does it affect the hearing? 

A. The exceedingly primitive structure of the 
internal auditory mechanism necessitates abnormal 
or defective hearing power. 

Q. Can congenital deaf-mutism be thus accounted 
for? 

A. There is no question but that arrest of develop- 
ment of the auditory mechanism places if in a condi- 
tion not to appreciate sound. 

Q. Does this affect the child, though he may not 
have been born deaf? 

A. Deaf-mutism from inability to appreciate sound 
occurs, and the whole auditory apparatus subsequently 
furthers degeneration. 

Q. Does mental weakness aggravate the condi 
tions? 

A. It has much to do with such cases. 

Q. Are closure of the Eustachian tube and absence 
of external ear infallible signs of deafness? 

A. No. 

Q. Must the complicated mechanism of the ear 
bones necessarily be a rich field for degeneracy? 

185 



186 QUIZ COMPEND 

A. Yes. Many ear lesions are no doubt due to 
such deformities. 

Q. Are deformities of the jaws and teeth common 
among deaf-mutes? 

A. Of 143 congenital deaf-mutes, ninety-three per 
cent, had deformities of the head, face, jaws, and 
teeth. 



CHAPTER XXL 



DEVELOPMENTAL NEUROSES OF JAWS OF THE 
SEEMINGLY NORMAL. 

Q. What did the examination of 1,000 seemingly- 
normal school children show? 

A. They showed normal 76 per cent, large jaw 1.9 
per cent., protrusion lower jaw .7 per cent., protrusion 
upper jaw .7 per cent., high vault 5.6 per cent., 
V-shaped arch 1. 1 per cent., partial V-shaped arch 

6.1 per cent, saddle-shaped arch 3.3 per cent, small 
teeth 3.0 per cent. 

Q. What did 1,000 seemingly normal adults show? 
A. They showed normal 61 per cent., large jaw 

3.2 per cent., height of vault 11.0 per cent., V-shaped 
arch 3.5 per cent, partial V-shaped 7 2 per cent., 
semi V-shaped arch 1.8 per cent., saddle arch 4 3 per 
cent, partial saddle 5.1 per cent, semi-saddle 3.4 per 
cent 

Q. What variation is noticed in different ages? 

A About fifteen per cent, more deformities in the 
adult. 

Q How may this be explained? 

A In two ways* (i\ That as people grow older 
slight irregularities of the teeth may become some- 
times more prominent, owing to movement and per- 
manent arrangement of the teeth later in life. (2) 
Some of those examined are patients who presented 
deformities that alarmed them. The percentage of 
deformities compares favorably with the percentage 

187 



188 QUIZ COMPBND 

of deformities of the face. Taken - as a whole, they 
give an approximate idea of the pereentage of deform- 
ities, in this community at least. 

Q. How do defectives compare with normal as 
regards deformifies? 

A. The percentage is from twenty-five to thirty- 
three per cent, less than found in institutions for 
defectives. 



\ 



CHAPTER XXIL 



DEVELOPMENTAL NEUROSES OF THE MAXILLARY 

BONES. 

Q. Are excessively developed jaws often seen? 

A. Yes. Either from natural growth or disease. 

Q. At what time does the jaw attain its growth? 

A. It has attained its full size at from twenty-five 
to thirty-five years of age. 

Q. Why so late? 

A. Because in neurotics and degenerates partial 
arrest takes place at different periods, after which the 
jaw will start up again and continue to grow* Assim- 
ilation is often slow, and the building up of structure 
is not complete until thirty to thirty-five. 

Q. Does the jaw usually correspond with the shape 
and size of the head? 

A. Other things being equal, a large head will 
contain a large jaw, a small head a small jaw, a broad 
head a broad jaw, a long head a long jaw. 

Q. Does the opposite sometimes occur? 

A. Yes. Occasionally a very small jaw is observed 
in a very large head, and vice versa. 

Q. Are both jaws uniformly affected? 

A. They are not. The upper jaw is more subject 
to morbid influences than the lower. 

Q. Why? 

A. Because it is connected with the bones of the 
head, of which it is a part. As a fixed bone the blood 
supply is reduced. 

189 



190 QUIZ COMPEND 

Q. How about the lower? 

A. While the lower rarely exceeds the average, a 
constant use and mobility has a tendency to keep it 
normal The influence which tends to check the 
upper is in the lower, thus overbalanced by its 
mobility 

Q. Does use increase the size of the jaw? 

A. Constant use increases the size, as in acrobats, 
tobacco chewers, singers, public speakers, and in the 
early races, which lived upon shells, roots, etc. 

Q. Does enlargement of the maxillaries occasion 
dental irregularities? 

A. Yes. The teeth of one jaw may extend inside 
or outside of those on the opposite jaw. 

Q. What diseases may cause this enlargement? 

A. Hypertrophy on the one hand, hyperplasia on 
the other, as well as osteitis and periostitis. 

Q. Will diseases of the antrum cause enlargement 
of the upper jaw? 

A. Yes. Diseases of the antrum and nasal fossae 
will produce the same result, 

Q. Does syphilis affect the jaws? 

A. Yes. Hereditary syphilis has a special predi- 
lection for the bones of the face and jaws. This is no 
doubt due to their transitory nature. Especially is 
this true of the alveolar processes. 

Q. Is the same form of irregularities of the teeth 
found in large jaws as small? 

A. V and saddle-shaped arches, with their modifi- 
cations, are never found in large arches. 

Q. In what disease of children are jaw abnormali- 
ties liable to occur? 

A. In rachitis, whether due to syphilis or not, 



on Irregularities' of the teeth. 191 

hypertrophy and hyperplasia may be localized in 
some portion of the jaw, causing it to be unevenly 
developed. 

Q. Is there jaw as well as face asymmetry? 

A. Yes. It is very common among neurotics and 
degenerates, and among the offspring of mixed races. 

Q. Why? 

A. Each lateral half of the body develops inde- 
pendently of the other. The same is also true of the 
jaws. Each has its own peculiarities. Asymmetry, 
therefore, is caused from the inharmonious lateral 
development of the parts. 

Q. Is it common? 

A, Extreme asymmetry of the lateral halves is 
often seen. Although it may not affect the contour 
of the face, it causes faulty articulation of the teeth 
upon that side of the face. 

Q. What is a local cause of asymmetry of the face? 

A. A full set of teeth upon one side with mastica- 
tion upon that side alone ; on the other side one or 
more teeth may have been extracted, or they may not 
erupt, or they may have moved forward upon one side. 
In any of these conditions the alveolar process and 
jaws would become shorter on one side than on the 
other. 

Q. What is this deformity called? 

A. Haskell's deformity. 

Q. Why? 

A. Because Dr. L. P. Haskell first called the 
attention to it. 

Q. In this deformity what produces marked depres- 
sion on the side of the face? 

A. It is properly due to asymmetry in the develop- 



192 QUIZ COMPEND 

ment of the two halves of the face. In mastication 
and in the eruption of the teeth they are forced into a 
larger circle; in this manner the circle of the alveolar 
process becomes larger than the circle of the jaw 
proper. 

Q. Is it customary to masticate upon both sides of 
the mouth? 

A. Yes. Although just as a person is right and 
left handed, so may he masticate either upon the right 
or left side. 

Q. Are these deformities apparent to the casual 
observer? 

A. They are not. Only when artificial teeth are 
inserted, or an irregularity corrected, can these 
deformities be detected. 

Q. Are not the rami frequently abnormally devel- 
oped? 

A. They are. It is not uncommon to find one 
ramus from one-fourth to one-half, and sometimes 
three-fourths of an inch shorter than that on the other 
side. 

Q. What effect does it have upon the body of the 
jaw and the teeth? 

A. It throws the jaw and teeth to one side, making 
a marked deformity. 

Q. May not the body of the jaw be longer and 
larger upon one side than upon the other? 

A. It is not uncommon to find one side longer than 
the other. 

Q. How can this be detected? 

A. By the position of the median line, and also by 
the occlusion of the teeth. 

Q. Where the inferior maxilla is normal or exces- 



ON IRREGULARITIES OF THE TEETH. 193 

sively developed, the superior maxilla quite small, 
and the alveolar process thin, what may occur? 

A. This condition will force the lower jaw and 
teeth against the upper, carrying the teeth and 
alveolar process forward, producing a marked protru- 
sion of the process and teeth. 

Q. What effect has this condition in negroes? 

A. It has a tendency to perpetuate the prognath- 
ism of the jaws. 

Q. What other cause may produce this deformity? 

A. A short rami. 

Q. What effect does such a deformity have upon 
the face? 

A. It usually produces marked depression of the 
face at the alae of the nose. 

Q. When the superior maxilla is fully developed, 
and the lower jaw cannot force the teeth and alveolar 
process forward, what results? 

A. The first molars erupt normally and occlusion 
is perfect until the second teeth come into place. 
Owing to the short rami the harmony is lost, and the 
second molars only articulate. The anterior part of 
the mouth remains open. 

Q. When excessive development of the rami takes 
place, what occurs? 

A. The body of the lower jaw may be brought 
forward, so that it protrudes quite a distance beyond 
the upper. 

Q. Can the rami be normal while the body is exces- 
sively developed? 

A. Yes. Such a case was observed in a School of 
Idiocy in Hamburg. The inferior incisors extended 
one inch beyond those of the upper. 



194 • 



QUIZ COMPEND 



Q. When the mobility of the lower jaw is favora- 
ble to a healthy, normal development, does the jaw 
ever become arrested? 

A. It is not uncommon to find the jaw arrested; 
when this is the case the person has the appearance of 
having lost the chin. 

O. What peculiar feature has the Yankee or Amer- 
ican type of jaw? 

A. It has a short rami, long slim, body and pro- 
truding chin. The face is thin. The alveolar process 
and teeth. are normal. Delicate muscles and tendons 
are associated with such bones. 

Q. Will not such a jaw become easily dislocated? 

A. Dislocation is liable to occur while yawning or 
during dental operations. Great care should be used 
to avoid too much leverage. 

Q. Does not the superior maxilla sometimes shut 
inside of the lower? 

A. Occasionally the upper jaw will become arrested 
to the extent that it will entirely close inside the 
lower, as in the case of Charles V. of Germany. 

Oo Do extreme cases of abnormal jaw development 
occur? 

A. Complete absence of the inferior maxilla occurs, 
but is rarer in man than in animals. It has been 
most noted in sheep. On the other hand, excessive 
development of the lower jaw in the bull-dog is quite 
common. 



CHAPTER XXIII. 



DEVELOPMENTAL NEUROSES OF THE VAULT. 

Q. Who first called attention to the relation of the 
palate or vaults in idiots? 

A. Dr. Langdon Down. After careful measure- 
ment of the mouths of the congenitally feeble-minded 
and of intelligent people he found that there was 
a markedly diminished width between the posterior 
bicuspids of the two sides. One result, or rather accom- 
paniment of the narrowing is the inordinate vault- 
ing of the palate. It assumed a roof-like form. The 
vaulting is not simply apparent from the approximate; 
it is absolute. The line of juncture between the 
palatal bone occupying a higher plane. 

Q. What did he conclude? 

A. That the condition of the mouth is important in 
determining whether the lesion on which the mental 
weakness depends is of intra-uterine or post-uterine 
origin. In the event of the mouth being abnormal, 
it indicates a congenital origin, while if the mouth is 
well formed, and the teeth are in a healthy condition, 
it would lead to the opinion that the condition had 
occurred subsequently to embryonic life. 

Q. What do these, when found in children, indi- 
cate, according to Dr. Down? 

A. Idiocy. But while many idiots and imbeciles 
have low, narrow vaults, many sane people have high 
vaults, and V-shaped and saddle arches. 

16 195 



196 QUIZ COMPEND 

Q. What did Clay Shaw decide? 

A. His researches showed that while there is no 
necessary connection between a high palate and a 
degree of mental capacity of the individual, a high 
palate is invariably associated with narrow pterygoid 
width and a narrow skull. 

Q. On examination of Clay Shaw's results, what 
conclusion was arrived at? 

A. That the intellectual standard adopted was too 
limited to admit of his sweeping assertion as regards 
mental capacity. 

Q. What was further shown? 

A. The claim anent narrow skull and high palate 
is a sweeping assertion, based on a few selected cases. 
Examination of the skulls in any moderately-sized 
anthropologic collection will disprove this assertion. 

Q. What is Cuylitz's theory? 

A. The claim of the connection of high vaulted 
palate with mental deficiency, asserted in explanation 
that the brain tends to develop transversely, but 
meets in some cases a resistance in the parietal region, 
which crowds it back. This pressure is transmitted by 
the zygomatic, temporal, and malar processes pushing 
together; the alveolar borders of the superior maxil- 
lary, like a workman's tongs, bring the ends together. 

Q. Does this theory seem plausible? 

A. While this explanation is exceedingly ingenious, 
it is as yet in the earliest stages of a working hypoth- 
esis. 

Q. What is idiocy? 

A. It is but a bud on the tree of degeneracy, and 
many conditions of checked development found in 
idiocy are found in other forms of degeneracy as well. 



ON IRREGULARITIES OF THE TEETH. 197 

Q. What has been the theory since Imrie's time? 

A. The theory that rabbit-mouth is due to keeping 
the thumb in the mouth for hours after going to sleep, 
has, with various modifications, but without careful 
analysis, been repeatedly reiterated in parrot-like 
fashion. 

Q. Who was the first to corroborate Imrie? 

A. Thomas Ballard claimed that "as in idiots are 
seen the worst forms of deformed growth, so also do 
they exhibit the most aggravated forms of deformed 
jaws and teeth, the habit of sucking being retained 
by them to advanced age." 

Q. Why is thumb-sucking an illogic theory? 

A. When the size of the vault, especially its 
anterior-posterior diameter, is compared with the 
thumb, lip, tongue, sugar teat, etc., it is evident that 
depression made by them could not produce uniform 
width and height throughout the entire length of the 
vault. 

Q. How early do children commence to suck their 
fingers? 

A. Soon after birth. As absorption and deposi- 
tion of bone cells take place faster at that time than 
at any other in life, high, narrow, deformed vaults 
would be expected in connection with the first set of 
teeth or before the sixth year, but such is not the case. 
Children with the habit of finger-sucking often have 
very low vaults. 

Q. What were Clouston's conclusions? 

A. He divides vaults into three groups, typical (or 
normal), neurotic, and deformed. The first has a low, 
but regular wide dome. The second type is designated 
as neurotic, because, according to Clouston, the "de- 



198 QUIZ COMPEND 

formity of the palate occurs during the brain growth 
early in life, probably in utero, " and the third is 
designated as deformed. 

Q. Are these conclusions of value? 

A. They are' not, since they are largely based on 
preconceived notions, which ignore the researches of 
comparative anatomists, of alienists of world-wide 
fame, of embryologists, of ethnologists and of crimi- 
nal anthropologists. 

Q. In a general way, what are the theories of 
Clouston, Langdon Down, and Cole? 

A. That excessive vaulting of the palate is due. to 
arrest of development of the sphenoid boae and pre- 
mature ossification of the sutures at the base of the 
skftll, 

Q. What precludes these theories? 

A. If the intervening space between the base of 
the brain and the vault were solid, a change in shape 
of one might exert an influence upon the other. The 
space occupied by the nares being located between the 
two, with two strong pillars of the superior maxil- 
lary bones upon either side as a resistance, precludes 
such a theory. That any force produced by the devel* 
opment of the bone at the base of the skull, or early or 
retarded ossification of suture in that locality, could 
exert an influence through the vomer is not well 
taken. 

Q. What are other evidences that influences in this 
direction cannot change the shape of the vault? 

A. The fact that the vomer does not ossify until 
puberty, the thinness of the bone after ossification, and 
that it is always crimped or deflected in one direction 
or another, is evidence that no effect could be pro- 



ON IRREGULARITIES OF THE TEETH. 199 

duced upon a vault of bone, supported by the anterior 
alveolar process, and with a rib or suture extending its 
entire length, which ossified years before any change 
in the vault was noticed. 

Q. Does the theory of Clouston that "the deform- 
ity of the palate occurs during brain growth early in 
life, probably in utero," seem plausible? 

A, It does not. The brain continues to grow until 
the sixth or seventh year. The vault does not change 
very much until after the second teeth erupt, after the 
sixth year, hence a high vault cannot be said to 
develop early in life, much less in utero. 

O. What is Ivy's theory? 

A. That dental and facial types are a part of the 
morphology of the temperaments. That the vault is 
'indicative of the several temperaments. That the 
vault of the bilious temperament is about flat, the 
dome of the mouth is high and about square. The 
sanguine vault resembles a horse-shoe in shape, the 
dome of the mouth is high and semi-circular. The 
nervous-temperament vault is Gothic, from its pointed 
character. The lymphatic vault is also semi-circular. 
and somewhat resembles that of the sanguine temper- 
ament. 

Q. Do these theories seem plausible? 

A. They do not. The mouths of each class, 
bilious, sanguine, nervous, or lymphatic, may range* 
from 2.50 inches across from one second bicuspid to 
that of the other side, down to .96 inches in width, and 
the antero- posterior diameter from. 2.43 down to 1.86 
inches. The height of vault from .86 down to. 25 
inches. These figures in themselves preclude any such 
classification. 



200 QUIZ COMPEND 

Q. How would heredity affect the vaults? 

A. Two individuals, one a nervous, the other a 
lymphatic, bilious, or sanguine temperament, are 
married, the offspring inherits the jaws of one, the 
teeth of the other; the temperament of the child is 
changed. One child may possess a broad dental 
arch, but very short, another a very narrow, long 
dental arch. Hence classification of the dental arch 
and vault by temperaments is out of the question. 

Q. Is there further evidence that such classifica- 
tion is impossible? 

A. Investigations were carried out upon brachy- 
cephalic, mesocephalic, and dolichocephalic individu- 
als, which demonstrated that classification of vaults by 
the shape of the head could not be accomplished. 

Q. What other theories have received much en- 
couragement? 

A. Mouth-breathing has been advanced as a cause 
of high vaults, and is still held by medical men and 
dentists. 

Q. How is mouth-breathing produced? 

A. That mouth-breathing is caused by sleeping 
with the mouth open, by enlargement of the tonsils, 
by adenoid growth, by hypertrophy of the mucous 
membrane of the nose and turbinated bones, and by 
arrest of development of the nose and upper jaw. 

Q. What theory has been advanced as to the effect 
upon the jaws and teeth? 

A. The mouth being open, pressure is brought 
upon the jaws and teeth by the buccinator muscles, 
causing contraction of the dental arches. 

Q. Is such a theory in harmony with the facts? 

A. It is not. The buccinator muscle is a voluntary 



on Irregularities of the teeth. 201 

muscle, penniform in shape. It has its origin and 
insertion along the body of the jaws, above and below 
the alveolar process. It extends from the first 
bicuspid anteriorly to the third molar posteriorly. Its 
chief function is to convey and hold food under the 
teeth in mastication. Being a voluntary muscle it 
could not contract during sleep. 

Q. Does mouth-breathing commence very early in 
life? 

A. Yes. Contracted jaws and vaults are never 
seen until after the sixth year. If they exist they are 
premature senilities or due to traumatic causes. 

Q. Are high vaults and contracted arches always 
present in mouth-breathing? 

A. Only in a very small percentage. 

Q. How the mouth opened in mouth- 

breathing? 

A. The lower jaw drops just enough to allow the 
same volume of air to enter that would pass through 
the nose, about one-half inch. 

Q. Do old people sleep with the mouth open? 

A. They do. Not from closure of the nostrils, 
however, but on account of relaxation. 

Q. If mouth-breathing were thecause of contracted 
dental arches, would it have any effect upon the jaws 
and teeth in old age? 

A. It would not, because the deformity is always 
complete by the twelfth year. 

Q. Is there tension upon the dental arches when 
the mouth is opened? 

A. There is not. When the mouth is open there 
is a slight sense of tension of the orbicularis oris, but 



202 quiz <:ompend 

not of the buccinator, no matter how wide the mouth 
is opened. 

Q. If it were possible for the buccinator to exert 
pressure, would it produce the V-shaped arch? 

A. It is an impossibility, because it does not 
extend forward far enough. 

Q. Having disposed of the V-shaped vault, what 
effect would the buccinator muscle have upon the 
saddle-shaped dental arch? 

A. As has already been said, this muscle is a pen- 
niform structure. The center of contraction is at, or 
about, the first molar tooth. The first permanent 
molar and the teeth posterior to it are never involved 
in either deformity, only the teeth anterior to the first 
permanent molar. 

Q. That being the case, could not one-half of the 
muscles act upon the bicuspids and cuspids? 

A, Suppose one-half of the muscles could contract 
upon these teeth, the result would be that the deform- 
ity would be uniform upon both sides, and always 
alike on each side. 

Q. Is not that the case? 

A. It never is the case. Frequently only one tooth 
is inside of the arch; again one is on the outside. 

Q. Does the theory seem tenable? 

A. It is perfectly absurd; since the dental arch is 
not unlike the arch of a bridge, or the arch in a build- 
ing, pressure exerted upon the outside would have no 
effect upon it. If such a theory were correct, what 
would be the cause of the partial V and saddle, and 
the semi-V and saddle arches? 

Q. Is there further evidence that mouth-breathing 
is not the cause of these deformities? 



on "irregularities of the teeth 203 

A. In the mouths of twenty-four mouth-breathers 
not a single complete V or saddle arch was observed 
Partial V and saddle and semi-V and saddle arches 
were common, but in no case were there any two alike. 

Q. How are deformed vaults accounted for? 

A. By studying their development, the production 
of normal and deformed vaults can be understood. 

Q. How was this accomplished? 

A. First, by settling the question that deformed 
vaults are not observed among children with tempo- 
rary teeth. The jaw grows from birth until the second 
period of stress, about the sixth. It is at this period 
that the second set erupt. Second, thirty-six impres- 
sions of the mouths of children, ranging from six to 
twelve years, were taken and casts obtained. 

Q. Were the children picked cases? 

A. They were not, only so far as age was con- 
cerned, The impressions were taken in modelling 
compound to get an accurate impression of the soft 
palate. Measurements were first taken, and then the 
models were sawed at the median line. 

Q. How were the lines traced? 

A. They were placed upon paper and traced. They 
were then glued together and sawed transversely 
anterior to the first permanent molar. They were 
again placed on paper, and traced transversely. In 
this way the illustrations were accurately outlined. 

Q. Were the plates made of the models before they 
were cut into sections? 

A. They were, and -may be found in the third 
edition of Talbot's work. These, together with 
plates one to twelve in the appendix, give a very good 



204 QUIZ COMPEND 

idea of the progress of development of the permanent 
teeth and alveolar process. 

Q. Were the changes very great at first? 

A. There were three models at six years, and three 
at seven. The changes in the vault are so slight that 
more would be useless. 

Q. What does this signify? 

A, That only the first permanent molars were in 
place, and that the change in the alveolar process only 
takes place when the second teeth come into place. 

Q. What is the condition of the vault at this time? 

A. In a general way the vaults are quite low and 
without character. 

Q. What does a cross section show? 

A. It shows that the vault is quite narrow at the 
upper portion, and the lines in either direction 
diverge until the teeth are reached. The teeth also 
diverge outward. 

Q. What is the condition of the alveolar process? 

A. The alveolar process is quite thick at six and 
seven years, but lengthens and becomes thinner as 
age advances. 

Q. What causes the thickness? 

A. The antrum is situated between the inner and 
outer plate of bone, and the scanty alveolar process 
contains not only the roots of the temporary teeth but 
also the crowns of the permanent teeth. 

Q. Is advance in height of vault very rapid? 

A. It is not. The advance is very gradual from 
year to year, yet taken as a whole, from the sixth to 
the twelfth year there is quite an advance in height 

Q. When is the normal height attained? 

A. When all of the permanent teeth are in posi- 



ON^IRREGULARITIES OF THE TEETH. 205 

tion and the alveolar process has developed about 
them. 

O. Do the two sides develop the same length? 

A. With but f ewexceptions they will be nearly alike. 

Q. Does the vault along the median line change its 
shape in any way while this development is going on? 

A. It does not. The change is always at the 
alveolar process. 

O. When does the greatest change take place in 
the alveolar process and vault? 

A. Between the ninth and twelfth year, when the 
bicuspids come into place. It is at this period that 
the vault takes on character in outline. 

Q. When do the changes which produce deform- 
ities in the vault begin? 

A. About the tenth or eleventh year, or when the 
bicuspids erupt, the change takes place, and from that 
time on until all are in place. 

Q. Is the vault deformity due to erupting teeth? 

A. Yes. 

Q. Does the character of the deformed vault depend 
entirely upon the shape of the alveolar process, and 
the shape of the alveolar process upon the shape and 
position of the teeth? 

A. This is true. 

Q. What determines the shape of the dental arch? 

A. The eruption of the teeth is purely mechanical. 
The size of the jaw is the basal principle. The charac- 
ter and severity of the deformity depend upon the 
order of development. 

Q. What is meant by the size of the jaw being the 
basal principle? 

A. If the jaw be smaller than the long diameter of 



206 QUIZ COMPEND 

the teeth, or m other words, if arrest of development 
has taken place, then the teeth will come in irregularly? 

O. What are the types of the dental arches? 

A. The two principal types are V and saddle 
arches; all other forms are modifications of these two 
forms. 

Q. What effect have local irregularities of the teeth? 

A. The vaults often become deformed from local 
irregularities. 

Q. Does the suture become excessively developed? 

A. It does. It may develop as early as the second 
and as late as the thirty-sixth year. : 

O. What is the cause of excessive development? 

A, It is due to irritation in mastication ; ossification 
varies in different persons. 

Q. Does this excessive development vary in differ- 
ent individuals? 

A. It does. It takes different shapes and forms. 
This in 228 Peruvian skulls, 240 Stone Grave skulls, 
and twenty-one Mound Builders' skulls, sixteen Peru- 
vians, thirty-nine Stone Grave and one Mound Builder 
had rope-like projections extending the entire length 
of the suture. This development was unlike the ex- 
cessive development of modern skulls. It had the 
appearance of having been made and then glued upon 
the suture. 

Q. How do these sutures differ? 

A. They vary in proportion to the width of the 
arch. In narrow arches the suture is low or thick, 
which in a normal arch is flat. The grooves on either 
side of the suture are not uniform, one side being 
deeper than the other. 

Q. What are some of the theories as to cause? 



ON IRREGULARITIES OF THE TEETH. 207 

A. Clouston says, " those palates where the de- 
formity consists in a ridge down the center antero- 
posterior^, seem to show that in them the deformity 
took place at a later period than in the other deformed 
palates/' When the nasal septum was getting strength 
and kept the center of the palate down, while on each 
side of it the palate was drawn up, making two 
vaults, side by side, instead of one? 

Q. Is hypertrophy more common in neurotics and 
degenerates than in normal people? 

A. Yes, since the suture is slower in ossifying. 

Q. Are they visible as early as two years of age? 

A. Yes, they are very distinctly seen. 

Q. Does the depression on the side of the ridge 
vary in shape? 

A. The ridge takes so many different shapes that 
when a number of models containing it are examined, 
the theory that the sides are drawn or pushed up 
appear more and more untenable. 

Q. Where are these grooves located? 

A. Sometimes in the posterior third, again in the 
middle third, and still again in the anterior third, 
including deep grooves in the alveolar process. The 
vomer certainly could not have any effect upon the 
ridge or depression in that part of the mouth. 

Q. Will hypertrophy account for all the depres- 
sions in the vault? 

A. No. Some result from hypertrophy of the 
alveolar process. 

Q. May a deep groove occasionally be seen along 
the line of the suture? 

A. Yes. It seems due to arrest of development of 



208 QUIZ COMPEND 

the suture with hypertrophy of the bone and mucous 
membrane. 

Q. Is it always uniform? 

A. No. Sometimes it is shallow, again deeper, 
sometimes broad, and again narrow, dependent upon 
the extent of the hypertrophy. 

Q. How are these deformities produced? 

A. The lower jaw develops laterally faster than the 
upper, thus crowding the superior maxillary bone 
apart in mastication. 

Q. Can this spreading be demonstrated in another 
way? 

A. The space between the central incisors is a 
marked illustration. The development of bone in the 
suture is so hard that it is difficult to draw the teeth 
together. It is more difficult to keep them in posi- 
tion. 

Q. What conditions of the jaws are noticed when 
grooves are present? 

A. When grooves are found in the vaults, there 
are most always small contracted jaws. The alveolar 
process is nearer the center of the vaults. This, 
together with the ridge, produces the grooves. 



CHAPTER XXIV. 



DEVELOPMENTAL NEUROSES OF THE PALATE. 

Q. In embryonic life how are the nares separated 
from the mouth? 

A. By a partition between the nasal pits and the 
cavity of the .mouth. 

Q. What becomes of this partition? 

A. It becomes the true hard palate, containing the 
intermaxillary bones. 

Q. What two cavities are then found? 

A. Above this partition are the two nasal cavities; 
below, the oral cavity. 

Q. What structure is then added? 

A. The soft palate. 

Q. What cavities does it separate? 

A. The upper respiratory passage and a lower 
lingual or digestive passage. 

Q. How are they developed? 

A. By two shelf-like growths on the inner side of 
each maxillary process. 

Q. Where do they unite? 

A. The union is completed at the median line. 

Q. What becomes of these palate shelves? 

A. They descend a certain distance into the 
pharynx, but in the pharynx their growth is 
arrested. 

Q. What becomes of them? 

A. At first they project obliquely downward toward 

209 



210 QUIZ COMPEND 

the floor of the mouth. The tongue rises high between 
them and appears in sections, which pass through the 
internal nares, to be about to join the internasal 
septum. 

Q. What becomes of the floor of the mouth? 

A. As the lower jaw grows the floor of the mouth 
is lowered, and the tongue is thereby brought farther 
away from the internasal septum. 

Q. What becomes of the palate sheives? 

A. They take a more horizontal position, and hdve 
turned the median line above the tongue and below 
the nasal septum to meet and unite. 

Q. Where do the shelves meet first? 

A In front, toward the lip, and then behind 
toward the pharynx later. 

Q. At what period of the embryo does this union 
begin? 

A. At eight weeks, and at nine weeks is completed- 
for the hard palate; at eleven weeks for the soft 
palate. 

Q. Where do the palate shelves extend? 

A. Back across the second and third brachial 
arches, by the migration of the first gill cleft, or in 
other words, of the Eustachian tube. 

Q. Where is the Eustachian opening? 

A. It lies above the palate (uvula), while the 
second cleft remains lower down, and lies below the 
palate as the anlage of the tonsil. 

Q. At what time does the uvula appear? 

A, During the latter half of the third month, as a 
projective of the border of the soft palate. 

Q. At what time does the nasal septum unite? 

A. Soon after the two palate shelves have united; 






ON IRREGULARITIES OF THE TEETH. 211 

thereby the permanent or adult relations of the cav- 
ities are established. 

Q. What are the views of Beaunis and Bouchard in 
regard to the development of the mouth and surround- 
ing parts? 

A. " Beginning of third week — first pharyngeal 
arch; buccal depression. End of third week — coales- 
cence of the inferior maxillary protuberances; forma- 
tion of the three last pharyngeal arches. Fourth week — 
olfactory fossae. Fifth week — ossification of lower jaw. 
Sixth , week — the pharyngeal clefts disappear, the 
tongue, the larynx, and germs of teeth. Seventh 
week — points of ossification of intermaxillary bone; 
.palate and upper jaw (its first four points). Eighth 
week — the two halves of the bony plate unite. Ninth 
week — osseous nuclei of vomer and malar bone; the 
union of the hard palate is completed. Third month — 
points of ossification for the sphenoid and nasal bones; 
squamous portion of temporal orbital center of 
superior maxillary bone; commencement of formation 
of maxillary sinus; epiglottis. Fifth month — osseous 
points of lateral masses of ethmoid; ossification of 
germs of teeth; appearance of germs of permanent 
teeth." 

Q. What may occur at the fifth month from mal- 
nutrition? 

A. At or about this time is the first period of stress. 
As a result of hereditary defect or mal-nutrition, arrest 
of development may check the growth of tissue and 
the various types of degeneracy result. 

Q. Is cleft palate common? 

A. It is comparatively rare in proportion to other 
forms of nutritive degeneracies. 



212 QUIZ COMPEND 

Q. Is palate embryology a good study for certain 
symptoms? 

A. It throws certain light on etiology and prognosis. 

Q. What points may be derived? 

A. Since most cleft palates occur in defective indi- 
viduals, and since cleft palate predisposes to death by 
infectious disease, whose local manifestations are in 
the mouth and throat, those in whom cleft palate most 
occurs are liable to die before the completement of 
the sixth year. 

Q. Was cleft palate early associated with other 
defects. 

A. Early in the nineteenth century. Tiedmann 
noticed that in certain cases of cleft palate the olfactory 
nerve was absent or abnormal. He concluded, there- 
fore, the deformity was resultant upon atrophy of the 
nerve origin of the olfactory organ. M. J. Weber, 
after a careful analysis of all accessible cases, failed to 
find one in which the olfactory nerve was absent. 

O. What conclusions may be drawn at the present 
time? 

A. Coincidence of cleft palate and olfactory nerve 
atrophy discovered by Tiedmann probably result from 
the same central mal-development. They bear no 
causal relation to each other. 

Q. When coalescence of structure fails to occur, 
what takes place? 

A. Certain deformities are produced, chief of 
which are cleft palate and hare-lip. 

Q. Does this condition run in families? 

A. According to Bland Sutton it has been known to 
appear in several members of the same family, and 
to occur in the offspring of affected members. 



ON IRREGULARITIES OF THE TEETH. 213 

Q. Is cleft palate ever observed in animals? 

A. Instances of the transmission of this deformity 
have been traced from an affected pug bitch to her 
offspring. 

Q. Could a race of men, with hare-lip and cleft 
palate, be produced? 

A. There is no question that if it were possible to 
practice selective breeding in man, as in dogs, such a 
race could be produced. 

Q. What relation between brain and cleft palate 
has been claimed? 

A. That cleft palate results from excessive devel- 
opment of the anterior portion of the brain and skull, 
such as produces hernia cerebri, ventricular atrophy, 
or excessive anterior cerebral lobe development. 

Q. Does this theory hold good? 

A. This mixed patho-teratologic theory is not war- 
ranted by either embryology or clinical observa- 
tion. 

Q. What is Langdon Down's theory in regard to 
cleft palates? 

A. He found a constant relation between brain 
deformity, cleft palate, and deformed vaults, and sug- 
gests that "it is possible that it may arise, as has been 
suggested, from sphenoid, arrest of development, or 
vomer defects in development." 

Q. What has been shown on the other side? 

A. It has been plausibly shown that the contracted 
high vault is not due to the condition, and there can 
be no relation between contracted vaults and cleft 
palates. The cleft occurs before the tenth week of 
foetal life, while the contracted vault does not appear 
until after the sixth year. 



214 QUIZ COMPENO 

Q. Are cleft palates becoming more frequent dur- 
ing the present century? 

A. This opinion was supported by Oakley Coles on 
the ground that palatal vault deformities are more 
frequent, and that a relation exists between them and 
cleft palate. The relation between a high state of 
civilization and a high proportion of palatal deform- 
ities is something more than a mere matter of consid- 
eration. 

Q. What error did Coles make? 

A. In dealing with the influence of civilization he 
ignored all but its degenerative influences. Under 
civilization the defective classes are preserved ; further- 
more, this preservation extends particularly tq those 
under five years of age, who would be destroyed 
under primitive conditions. 

Q. How may cleft palates be divided? 

A. Into two classes, congenital and acquired. 

Q. What is meant by congenital? 

A. That it existed at birth. 

Q. What is acquired cleft palate? 

A. The result of disease. 

Q. How is congenital cleft palate divided? 

A. Into two kinds, complete and partial. 

Q. What is complete cleft palate? 

A. Here the fissure extends the entire length from 
the uvula to and including the anterior alveolar pro- 
cess and lip. It is partial when only a part of the 
structures are involved, 

Q. May only the anterior part be involved? 

A. The cleft may extend through the anterior 
alveolar process, involving only the incisive bones, 



ON IRREGULARITIES OF THE TEETH. 215 

which is very rare; when present, single or double 
hare-lip almost invariably exists. 

Q. What other deformities occur? 

A. Cases occur where only a small part of the an- 
terior alveolar process and jaw are involved, together 
with one or two teeth. The hard palate may be in- 
volved to the extent of a small fissure, or the whole 
bone may be wanting. The soft palate may only 
contain the cleft or simply the uvula. Cases are on 
record in which the non-development of the maxillary 
bones produces fissures in the lip. 

Q. Is cleft palate inherited? 

A. The view expressed by Bland Sutton and Oak- 
ley Coles would lead to that conclusion. Sufficient 
data have not been forthcoming to show that the 
actual presence of the deformity in the parent has had 
a direct predisposing influence upon the child. 

Q. Could maternal mental impression cause the 
deformity? 

A. It may be confidently stated the deformity 
cannot be produced from any impression received by 
the mother during pregnancy. 

Q. What are the chances of inheritance of cleft 
palate? 

A. In most cases which have come immediately 
under notice, when one of the parents had cleft palate 
all the children have been born perfectly developed, 
even though dread of transmitting the deformity was 
always present in the mind of the mother. In one 
case, curiously enough, there were three members of 
one family with cleft palate, one seventeen years of 
age, one thirty, and one thirty-five. The first and 
last are ladies, the other a gentleman, who is mar- 



216 QUIZ COMPEND 

ried, and has a family without the father's de- 
fect. 

Q. Was there any trace Qf cleft palate in the 
ancestor? 

A. No defect could be found either among the 
ancestors or collateral branches of the family. 

Q. Are there evidences of inherited cleft palate? 

A. Another family has the following remarkable 
history: G. H. C, born 1853, perfect. L. C, born 

1855, single hare-lip and cleft palate. J. F. C.^ born 

1856, perfect. F. W. C, born i860, double hare-lip 
and cleft palate. H. E. C, born 1863, perfect. The 
paternal grandmother likewise had cleft palate. 

Q. What is the percentage among degenerates? 

A, Knecht found five per cent, of 1,200 criminals 
examined to have cleft palates, and fourteen per cent, 
of the prostitutes examined by Pauline Tarnowsky 
had cleft palates. Langdon Down, among congen- 
ital idiots, found only half a per cent, of cleft palates. 
Grenser found nine cases in 14,466 children, or one in 
1,607. Talbot examined 1,977 feeble-minded children 
without finding a single case. In 207 blind but one 
case was observed. In 1,935 deaf mutes, two cases, 
or about one in 1,000. The percentage among the 
defective classes is undoubtedly much larger than 
among normal individuals, but early deaths explain 
the small numbers. 

Q. What is the history among animals? 

A Ogle found that ninety-nine per cent, of the 
lion cubs born in the London Zoological Gardens had 
cleft palates. This he ascribes to the artificial diet 
as the result of enforced captivity. Similar results 
in other gardens in Europe were charged to feeding 



ON IRREGULARITIES OF THE TEE*TH. 217 

the mother with meat without bone, since feeding 
with the whole carcass of small animals greatly 
diminished these deformities. If cleft palate were 
sometimes attributable to this cause, other bony 
structures should likewise be involved. It is, hence, 
not astonishing to find many lions in captivity were 
rickety. Cleft palate has been observed among dogs, 
sheep, goats, etc. The question, however, whether 
domesticity does not play in them the alleged part of 
civilization in man can be solved only by knowledge of 
the frequency of the condition among wild animals of 
the same family. 

Q. In dealing with etiology what must be taken 
into consideration? 

A. The influence of shock on the mother's nervous 
system cannot be excluded in the cases charged to 
feeding. 



CHAPTER XXV. 



DEVELOPMENTAL NEUROSES IN TEETH POSITION. 

Q. Are the jaws subject to arrest of, development? 

A. They are. 

Q. Why? 

A. They are transitory structures. 

Q.- Do periods of stress affect both jaws alike? 

A. They do not. 

Q. Which is the most subject to deformity? 

A. The upper. 

Q. Why? 

A. Because it is a fixed bone, and influenced by 
other bones of the head. 

Q. How do the periods of stress affect the jaw? 

A. They cause excessive and arrest of develop- 
ment. 

Q. Why do they produce both? 

A. Because of the law of economy of growth, which 
causes gain in one direction at the expense of another. 

Q. What deformities are produced? 

A. V and saddle shaped dental arches. 

Q. What local condition produces the same results? 

A. Premature extraction of the temporary teeth, 
thus allowing the first permanent molars to move for- 
ward and to diminish the space, thus causing tooth 
irregularities. 

Q. What structures are involved in these deform- 
ities? 

A. The structures involved in the formation of 

219 



220 QUIZ COMPEND 

these deformities are the jaws and alveolar process on 
one hand and teeth on the other. 

Q. What is the nature of these structures? 

A. The alveolar process is soft and yielding, while 
the jaws and teeth are composed of hard, dense sub- 
stances. The alveolar process adapts itself to the 
teeth, no matter what position they take. 

Q. What constitutes the dental arch? 

A. All the teeth when in position. 

Q. Do the teeth upon both sides of the jaw depend 
upon each other? 

A. They do not. The jaws and teeth, like the 
lateral halves of the body, develop independent of 
each other. Each possesses its own peculiar charac- 
teristics as regards irregularities of the teeth. 

Q. Huw can the classification of irregularities be 
simplified? 

A. By dividing each jaw at the median line into 
right and left, superior, right and left inferior dental 
arches. 

Q. Is such classification strictly correct from an 
architectural point of view? 

A. It is not, but for clinical purposes it is admirably 
adapted. 

Q. To what is the construction of these deform- 
ities comparable? 

A. To the construction of an arch, each tooth rep- 
resenting a stone. 

Q. Are development of the teeth and these peculiar 
formations purely mechanical? 

A. The time and movement of the teeth determine 
the character of the deformity, just as in chess or 
checkers, time and movement determine the result. 



ON IRREGULARITIES OF THE TEETH 221 

Q. What does each lateral arch contain? 

A. It contains teeth which correspond to the stones 
of an arch. 

Q. How are these stones laid? 

A. Their laying depends on the time of normal 
eruption of teeth. 

Q. Build a normal lateral arch. 

A. The first stone laid will correspond to the first 
permanent molar, and is called the ' 'posterior base. " 
The next stone laid is the central incisor, and is called 
the ''anterior base." The next stone is located 
upon the anterior base and corresponds to the 
lateral incisor. The next stones are the first and 
second bicuspids, and are laid upon the posterior base. 
The stone corresponding to the first bicuspid is usually 
in position first, but sometimes the stone correspond- 
ing to the second bicuspid is placed first. To complete 
the arch it is necessary to place the keystone in posi- 
tion — the cuspid. If the stones have been properly 
proportioned and measurement correct, the keystone 
will fit into its proper place, and the arch will be com- 
pleted. On examining the posterior foundation two 
more stones are found, these correspond to the second 
and third molars. These stones beneath the base and 
the stones above the base make a very strong abut- 
ment. 

Q. What constitutes a normal dental arch? 

A. There are three characteristics of a normal 
dental arch. Independent of temperament pecul- 
iarity, the lines extending from one cuspid to another 
should be the arc of a circle, not an angle or straight 
line; the line from cuspids to the third molars should 

18 



222 QUIZ COMPEND 

be straight, curving neither in nor out, the sides not 
approximating parallel lines. , 

Q. Should both sides be alike? 

A. Absolute bilateral uniformity is not implied, 
since the two halves of the human jaw are rarely if 
ever alike. 

Q. What does a uniform arch necessitate? 

A. Uniformity of development between the arch 
of the maxilla and the arch of the teeth, and a correct 
relation of the individual teeth to each other. 

Q. What must occur when disharmony results from 
inheritance of the small jaw of one parent and the 
large teeth of the other? 

A. Irregularities. 

Q. What are these called? 

A. Constitutional irregularities. 

Q. When there is a difference in the diameter what 
takes place? 

A. The line formed by the teeth must either fall 
outside or within the arch of the maxilla, and irregu- 
larities of a grave nature must result. 

Q. What happens in the construction of an arch if 
the diameter of the stones be too small for the curve 
on the bases, or be set too far apart? 

A. The keystone will not find support, and will 
drop through toward the center. 

Q. Is this very common? 

A. Yes. The cuspid points into the vault, or 
remains imbedded in the jaw. 

Q. Suppose the arch be too small, or the posterior 
base and foundation stones have been brought forward 
to the extent that there is no room for the keystone, 
what happens? 



ON IRREGULARITIES OF THE TEETH. 223 

A. The keystone remains outside the arch. 

Q. What happens if the arch be partly or wholly 
closed and the keystone be very heavy (has great lev- 
erage) ? 

A. The keystone will force the foundation or break 
the a.rch or both. The posterior base, with founda- 
tion, being so strong, it resists the force. The anterior 
base being weak, and without support, bulges out, 
and in this way the semi-V arch is produced. 

Q. How is the V arch produced? 

A. The posterior base is seldom, if ever, carried 
backwards, owing to the number of roots upon each 
tooth, and the broad, thick alveolar process to hold 
them. The anterior teeth all have round single roots, 
and are located in a thin alveolar process, easily bent 
out of position. The keystones, coming into place, 
crowd against the posterior base and cany the anterior 
bases and teeth forward, thus producing the V-shaped 
arch. 

Q. How many teeth are involved in the construc- 
tion of the V-shaped arch and its modifications? 

A. The ten anterior teeth. These teeth are all 
wedge-shape; the bases being thin cutting edges, and 
the apices at the end of the roots. They are also 
nearly round and conical, the points of antagonism 
being nearly or quite at the cutting edges. 

Q. Do these approximate surfaces assist in produc- 
ing irregularities of the teeth? 

A. They constitute the fulcrum of the lever, which, 
when force is applied to the teeth, causes them to 
rotate and move out of position, thus producing more 
varieties of deformities than it is possible to demon- 
strate upon the stone arch. 



224 QUIZ COMPEND 

Q. How is the germ of the cuspid loeated in rela- 
tion to the other germs in the jaw? 

A. It is outward and above on a line of a larger 
circle, 

Q. How does its root compare with that of the 
other teeth? 

A. It is much longer. 

Q. What results in eruption from this position and 
length of root? 

A, It is the most powerful tooth. Downward 'and 
inward movement, together with some pressure from 
the lips, will cause it to descend until it meets obstruc- 
tion great enough to resist further descent, locking 
the arch and holding the teeth in the proper posi- 
tion. 

Q. Where does the break occur when the cuspids 
come into place and there is not sufficient room? 

A. Always at the weakest point, 

Q. Where is this naturally? 

A. Anterior to the cuspid teeth. 

Q. Does the break always take place at the one 
locality? 

A. No. The break depends upon the weakness of 
the part and the position of the anterior teeth. It 
may be between the centrals, centrals and laterals, 
laterals and cuspids. 

O. Do teeth always take the same position? 

A. They do not. They may point outward or in, 
thus modifying the shape of the V. 

Q. Are two deformities absolutely alike? 

A. Although it is claimed that these deformities 
are a direct inheritance, and therefore alike, this in 
not the case. They are never directly inherited, and 



0N IRREGULARITIES OF THE TEETH. 225 

because they depend on mechanical environment they 
are never absolutely alike. 

Q. What is a partial V-shaped arch? 

A. When a line is drawn through the vault and the 
median line, if the incisors do not come to a point, in 
other words, if the anterior arches about half way 
between a V and normal, it is a partial V-shaped arch. 

Q. What is a semi- V-shaped arch? 

A. It is one where one side is V-shaped, and the 
other normal or nearly so. 

Q. Does the lower jaw ever assume a V-shaped 
arch? 

A. Never when the teeth of both jaws articulate 
normally. 

Q. Why? 

A. Because the anterior inferior teeth close inside 
of the upper, and forward movement is thus prevented. 

Q. Should the inferior dental arch be divided like 
the other? 

A. Yes. It should be divided into right and left 
like the upper, because the forward movement of the 
posterior column and the eruption of the cuspid exert 
the same influence as on the upper. Each lateral half 
has its bases and keystone. 

Q. Is the break in the arch the same? 

A. It is not, because the anterior base (the central 
incisors) is held in position by the superior incisors, 
and the break usually takes place at the cuspid teeth. 
The cuspids are carried forward. 

Q. Are the upper incisors sometimes carried for- 
ward? 

A. Yes. Sometimes the superior alveolar process 
is very weak, and the anterior force of the lower jaw 



226 QUIZ COMPEND 

is very great ; in such cases the superior incisors are car- 
ried forward and spaces will appear between the teeth. 

Q. Are saddle-shaped arches as common as the 
V-shaped? 

A. No. 

Q. Have they properties common to the V-shaped 
arch? 

A, They have many. 

Q. Name some. 

A. They may include one or both lateral arches. 
They may be partial on one side and normal on the 
other. Each lateral arch prpduces its own deformity 
independent of the other. The vault may be high or 
low. The deformity, like the V-shaped, is favored by 
the high arch. 

Q. How is the saddle-shaped arch produced? 

A. Like the V-shaped, there is the right and left 
lateral arches of stone. Each stone corresponds in size 
and location to the natural teeth. The first stone laid 
in the arch corresponds to the first permanent molar, 
and like the stone in the V-shaped arch, is denominated 
the posterior base. The next stone laid corresponds 
to the central incisors, then the stone which stands for 
the lateral incisor. The natural order now changes, 
and the next stone laid corresponds to the keystone of 
the V-shaped arch — the cuspid. This stone (the 
cuspid) forms the fixed anterior base, and is backed 
by the central and lateral teeth. The next stone laid 
corresponds to the first bicuspid, followed by those 
representing the second bicuspids and the second and 
third molars. The stones being in position, the anterior 
and posterior columns are nearly equal in strength 
and resisting power. 



ON IRREGULARITIES OF THE TEETH. 227 

Q. Does forward movement of the posterior col- 
umn take place under the same local conditions as in 
the V-shaped arch? 

A. In precisely the same manner. 

Q. Does the keystone (the cuspid) play the same 
part here? 

A. It does not, it is now a fixture. 

Q. Which are the weakest stones in this arch? 

A. They correspond to the bicuspids, and are the 
stones which are always displaced when the forward 
movement of the posterior column occurs. 

Q. Does this account for existence of fewer saddle 
arches than V-shaped? 

A. Yes. The change in the anterior base also 
accounts for the fact that the anterior teeth do not 
protrude in the saddle arch, while they always do in 
the V-shaped arch. 

Q. What great factors assist in the development of 
the saddle arch? 

A. The shapes and points of contact of the indi- 
vidual teeth. Their surfaces are not flat, but rounded, 
while the surface of the first permanent molar is an 
incline with the decline inward. 

Q. Why are the bicuspids not carried outward as 
well as inward? 

A. They are occasionally, but their eruption and 
environment are favorable to the inward movement, 
which is the natural case. 

Q. Are there other reasons for inward movement? 

A. Yes. The crowns of the bicuspids are situated 
between the roots of the temporary teeth, where the 
first permanent molar erupts. It develops outside and 
on a larger circle than the temporary set. When the 



228 QUIZ COMPEND 

temporary molar is extracted, the first permanent 
molar moves forward, and the incline holds the crown 
of the second bicuspid from taking the larger circle. 

Q. Having explained the local conditions, describe 
the method of formation of the saddle arches. 

A. The anterior and posterior bases being in place, 
the stones corresponding to the first and second bicus- 
pids being on a smaller circle, the posterior column 
moves forward, crowding the two teeth against the 
anterior base, both bases inclining inwards, carries the 
bicuspid inwards. This lateral movement continues 
until the teeth are locked tightly together. 

Q. How is the partial saddle arch formed? 

A. If the locking of the arch takes place between 
the cuspid and molar, the bicuspids are carried in a 
great distance and a partial saddle-arch is formed. 

Q. What is the semi-saddle arch? 

A. It is an arch where the deformity is only on 
one side. 

Q. Is a bicuspid occasionally carried into the vault? 

A. Yes. Usually the second. The second tem- 
porary molar holds the bicuspid on a smaller circle 
until all the other teeth are in place. When this is 
removed, the inclination of the crown is inward, the 
first permanent molar moves forward, and the incline 
pushes the bicuspid into the vault. The first molar 
continues its forward movement until it touches the 
first bicuspid, thus closing the arch. 

Q. How may a V-shaped and saddle arch be com- 
bined upon one side? 

A. Given a thin alveolar process, early or late ex- 
traction of the temporary molars, the posterior column 
moves forward, carrying the bicuspids inward. The 



onTirregularities of the teeth. 229 

cuspid comes down and from want of room the 
incisors are carried forward, the V-shaped arch will be 
developed forward, and the saddle arch at the side. 

Q. What shape will the opposite side take? 

A. It may be a V-shaped, saddle, or normal, de- 
pending upon the manner of eruption of the teeth and 
the amount of room provided for them. 

Q. Does the saddle arch occur upon the lower jaw? 

A. Saddle arches are observable upon the lower 
jaw. They form in the same manner as upon the upper. 
The force of the posterior column is often so great that 
the anterior base, the cuspid, is carried forward over 
the side of the arch. The laterals are carried inward. 

Q. In a general way what do these two forms 
resemble? 

A. Both are atavistic. The V-shape reverts to the 
reptilian type of jaw, w T hile the saddle arch reverts 
to the carnivora. 

Q. Are these deformities in perfect harmony with 
the laws of evolution? 

A. They are. Given a small jaw, the order of erup- 
tion of the teeth could not produce other than these 
two types of jaws or their modifications. 



CHAPTER XXVL 



LOCAL CAUSES OF TEETH IRREGULARITIES- 
UPPER JAW. 

Q. How are local irregularities formed? 

A. In malposition and malocclusion of individual 
teeth, as a result of an accident (such as premature or 
tardy extraction of the temporary teeth) or malposition 
and malocclusion resultant on constitutional causes. 

Q. What is the principal cause? 

A. Relative position of the first permanent molar. 

Q. How does it affect the position of the teeth? 

A. If the temporary molars be extracted prema- 
turely, the forward movement of the posterior column 
follows. The teeth in the anterior column are more 
or less influenced by vicious position, relation and 
occlusion. 

Q. Are temporary teeth moved forward by the 
permanent molars? 

A. Sometimes. Even tbe permanent cuspids at 
times yield. 

Q. What tooth is next in importance as to vicious 
influence? 

A. The cuspid. It asserts itself above the rest 
because of its vital force, length of root, peculiar shape 
and location in the jaw. The length of its root allows 
it to deviate most of any teeth from its original posi j 
tion. 

Q, Which is next? 

231 



2S2 QUIZ COMPEND 

A. The central incisor comes next in importance 
while the lateral is the most passive of teeth. 

Q. Why? 

A. Because it is the smallest and situated be- 
tween the two strongest in the anterior part of the 
mouth. 

Q. Is it very easily displaced? 

A. Yes. Because of its weakness and short, 
round root. 

Q. What effect has the forward movement bf the 
posterior column forcing the anterior column forward? 

A. Pressure brought to bear upon both sides 
makes the arch of the upper maxilla greater than the 
lower. 

Q. What effect does that produce? 

A. The result is that occlusion is wanting or 
defective, and flexion must take place according to 
position assumed in the eruption of each individual 
tooth. 

Q. Does the cuspid exert much influence? 

A. The force of the cuspid is spent upon the 
incisor. 

Q. Are the incisors quite large? 

A. They are at times owing to inheritance or 
vigorous growth. 

Q. Do they then exert more influence? 

A. They do; not so much in relation to position 
of the axes as in irregularities of the cutting edges. 
These from the excessive diameter overlap. 

Q. Do the temporary incisors when retained too 
long produce irregularities? 

A. If retained too long the permanent tooth is em- 
barrassed in its eruption. It seeks its way out as best it 



ON IRREGULARITIES OF THE TEETH. 233 

can and as erupting in straight lines is out the ques- 
tion, it slips around the root of the temporary tooth 
and is thus forced out of position. 

Q. Are not all anterior teeth influenced more or 
less in this way when temporary teeth remain too 
long? 

A. Yes. Great care should be exercised in remov- 
ing the temporary teeth at the proper period. 

Q. What is the most common form of irregulari- 
ties connected with the central incisor? 

A. That found in connection with the V-shaped 
arch. The force is applied from behind, the mesial 
edges touch and the teeth revolve upon their axis, the 
cutting edges are not in line but form an angle and 
point forward. 

Q. Is not this the most natural form for the flex- 
ion to assume? 

A. It is. The arch is simply broken in, its weak- 
est point following the general direction of the pres- 
sure. 

Q. Do these teeth ever overlap? 

A. It is a very common deformity. The edge 
being round sometimes the force in both directions is 
not alike, in which case one incisor is carried a little 
forward this causing the teeth to lap. 

Q. What other forms of deformity do the incisor 
teeth assume? 

A. When the cutting edges form an angle which 
is directed backward the pressure is from behind as in 
the other variety of deformities. 

Q. What forms do the laterals? 

A. When the cuspids come into place they crowd 
the laterals forward. It depends upon the occlusion 



234 QUIZ COMPEND 

with the centrals whether they remain in position or 
whether they pass in front or behind the centrals. 

Q. What different positions are assumed by the 
laterals? 

A. i. Mesial surf ace of lateral overlapping distal 
surface of central, while distal surface is in a line 
with cuspid. 

2. Mesial surface of lateral overlapping distal sur- 
face of central, while distal surface is behind the 
cuspid. 

3. Mesial surface of lateral behind the distal sur- 
face of the central, while the distal surface is in a line 
with the cuspid. 

4. Lateral in a line anterior to that of central and 
cuspid. 

5. Lateral in a line posterior to central and 
cuspid. 

6. Lateral at right angles with the line of the in- 
cisor and cuspid. 

7. Lateral wholly inside the arch. 

Q. Is the lateral often out of normal position? 

A. The lateral is more frequently out of position 
than any other tooth because it is the weakest in the 
arch and has the shortest root. 

Q. Upon what does its position depend? 

A. Upon the environment of its own side of the 
arch, independently of the other. 

Q. Besides its weakness, what also produces 
change of position? 

A. First, shortness and conical shape of its root. 
Second, its wedge shape crown. The shortness of its 
root, together with its conical outline, causes it to be 
more easily impinged upon by the root of the incisor 



ON IRREGULARITIES OF THE TEETH. 235 

which will produce partial rotation. The wedge shape 
of its crown facilitates rotation. 

Q. What results when diameter of cutting edge is 
greater than that of the root? 

A. The greater the degree of rotation must be 
before the lateral finds a resting place. 

Q. Are the laterals found wholly inside the arch? 

A. Sometimes. When the lateral, is tardy in 
eruption the cuspid comes into position and crowds 
the lateral into the vault. 

Q. Is the cuspid a very important tooth? 

A. It is the most important tooth in the anterior 
part of the mouth .on account of its durability and in- 
fluence on expression. Its durability is due to its 
hardness of tissue, its slowness of development and 
simplicity of shape. 

Q. Is it liable to decay? 

A. Because of shape and smoothness, it is less 
liable to caries. 

Q, Does it possess great strength? 

A. Yes. Owing to its position, length of root, 
together with its order of evolution. 

Q. Does position give it importance? 

A. Being placed between the anterior and poste- 
rior column, it forms the keystone and on account of 
its prominence gives expression to the face. 

Q. To what may be due deviation from the nor- 
mal? 

A. To malposition of the germ or crowding out 
of place. 

Q. How does time of eruption affect this tooth? 

A. It is late in erupting, therefore it must crowd 
its way into position. 

19 



236 QUIZ COMPEND 

Q. Is its crypt on a line with the other crypts? 

A. It is outside and above those of the other teeth. 

Q. What benefit results? 

A. It being above and on a larger circle, it can 
crowd in between the other teeth and crowd them 
apart, thereby spreading the arch, giving it a para- 
bolic outline and forming a keystone. 

Q. What effect has it upon the jaw when it re- 
mains inside or outside the arch? 

A. The expanded contour is lost and a .small 
pinched condition results, usually producing a V or 
partial V-shaped arch. 

Q. What results when the germs are misplaced in 
the arch? 

A. The cuspids may erupt in the vault, in the 
floor of the nose or they may remain imbedded cross- 
wise in the bone. 

Q. May one erupt normally and the other, irregu- 
larly? 

A. That is not uncommon. 

Q. Is bicuspid shape liable to interfere with nor- 
mal development? 

A. Yes. The antero-posterior diameter of its 
outer cusp is greater in proportion than the inner, 
producing a wedge shape space on the palatal side. 
This causes the tooth in front and back to touch at 
one point. 

Q. Which bicuspid is most liable to irregularities? 

A. The second. 

Q. What may cause irregularities of the bicuspids? 

A. Constitutional causes; lack of accord between 
the size of the jaw and that of the tooth or local 
causes. 



ON IRREGULARITIES OF THE TEETH. 237 

Q. What are local causes? 

A. Tardy eruption, deflection due to the retention 
of the temporary teeth, forward movement of the 
molar and rotation from want of occlusion. 

Q. Explain why. 

A. The natural order is first bicuspid, second 
bicuspid, cuspid. This is sometimes so changed that 
the first bicuspid is followed by the cuspid, thus push- 
ing it backward. From lack of space the second bicus- 
pid is crowded either without or within the arch. 

Q. What effect has deflection? 

A. When a temporary molar is retained too long 
or its roots are not absorbed as fast as the bicuspid is 
erupted, it is deflected or caused to rotate more or less 
upon its axis. 

Q. What effect has the forward movement of the 
molar upon the bicuspids? 

A. It necessarily diminishes the space left for the 
bicuspids and cuspids and when the first bicuspid and 
cuspid erupt before the second bicuspid, this may be 
crowded out of its proper place. 

Q. Does rotation produce a deformity? 

A. A rotation of the bicuspid from want of proper 
occlusion is not rare. The cusps of the bicuspids are 
designed to articulate with those upon the opposite 
jaw. When its two cusps fail to find an opposing cusp 
to keep it in place its function is lost. 

Q. Do not all these causes often work together? 

A. Frequently more than one of these causes are 
at work or one implies another. 

Q. How do irregularities of the teeth attract 
attention? 

A. They attract attention by their deformity and 



238 QUIZ COMPEND 

not by their interference with function. It is easy to 
observe displacement of individual teeth in the ante- 
rior dental arch. 

Q. Does the removal of a tooth cause irregulari- 
ties? 

A. As soon as a tooth is removed from a normal 
dental arch improper occlusion and articulation must 
result. 

Q. Which tooth is most often injudiciously ex- 
tracted? 

A. The first permanent molar. 

Q. Is it universally removed when decayed? 

A. Not in all countries. 

Q. Should it be removed? 

A. No. 

Q. What reasons are given for its removal? 

A. That the dental arch is small and by its re- 
moval it will give room for the other teeth to come 
into place. When removed early the other molars will 
move forward and fill the space. 

Q. Is this good reasoning? 

A. It is not. Malocclusion more or less will 
occur in every case. 

Q. What has been the cause of the removal of the 
first permanent molar? 

A. Its early decay brought about by the tax upon 
the growing child and neglect for which the teeth 
suffer during the period of its development. The 
parent usually does not know of its existence until the 
child complains of toothache. It is also removed to 
correct an overcrowded arch. 

Q. Does its extraction relieve the crowded arch? 

A. It does. More room is produced than is re- 



ON IRREGULARITIES OF THE TEETH. 239 

quired. As a result the remaining 1 teeth are out of 
position and their surfaces do not articulate properly 
with those upon the opposite jaw. 

Q. Has wholesale extraction of the first perma- 
nent molar had a beneficial effect? 

A. It has not. It is hastening arrest of develop- 
ment of the jaws and alveolar process since develop- 
ment of these depends largely upon the function of 
the teeth and their articulation for the motion stimu- 
lates nutrition and enlarges the arch, 

Q. What shows that arrest of development of the 
jaws takes place when the teeth are extracted? 

A. In every case when the germ of the teeth is not 
present or when a tooth becomes imbedded in the 
jaw, arrest of the bones takes place. 

Q. What effect does the loss of the first perma- 
nent molar have upon the individual? 

A. The loss of the first permanent molar impedes 
mastication and produces vicious occlusion and is det- 
rimental to the contour of the face. 

Q. What effect does malocclusion have upon the 
general health? 

A. The food is not properly masticated and the 
health may become seriously impaired. 

Q. In what other way is mastication interfered 
with? 

A. When teeth here and there are extracted, the 
arch is broken and the teeth are liable to move for- 
ward and backward, thus causing them to occlude 
between each other. These elongate and have no 
occlusal surf aces ; mastication is impossible. 

Q. May teeth extracted upon one side interfere 
with symmetry? 



240 



QUIZ COMPEND 



A. When the first permanent molar is prema- 
turely extracted upon one side, the position of that 
side is interfered with. The length of the rami, 
body, depth of sulci of the masticatory surfaces may 
be affected to such an extent that bi-lateral asym- 
metry results. 

Q. Should the first permanent molar be extracted 
when decayed? 

A. No. It would be better to fill the roots and 
replace, the tooth with a gold crown until all the teeth 
have developed and articulate properly. 

Q. Should there not be room for the third molar 
to come into place, what is, indicated? 

A. All the other teeth w r ill have erupted and 
found their proper positions by the time the third 
molar is ready to erupt ; if there be not room, extract 
the third molar 



CHAPTER XXVIL 



LOCAL CAUSES OF TEETH IRREGULARITIES- 
LOWER JAW. 

Q. Are the two jaws alike? 

A. The jaws are distinct in character, function 
and course of development. The upper jaw when 
normal describes a larger circle, the teeth overlap- 
ping the lower. It is fixed and depends for its func- 
tion on the activity of the lower. 

Q. Are irregularities as common upon the lower as 
upon the upper? 

A. Owing to the immobility of the upper, irregu- 
larities are more markedly constitutional than on the 
lower. Thus various abnormal dental arches are not 
seen in the lower while the high and narrow vault 
and inward curve of the alveolar process occurs. 
The lower is restrained by the overlapping of the 
upper. Motion of the lower jaw prevents deform- 
ities. 

Q. Are the lower teeth more liable to local irregu- 
larities than the upper? 

A. Yes, because the lower arch articulates inside 
of the upper. 

Q. How are the anterior inferior teeth arranged? 

A. The points of contact are at the cutting edge. 
The mesial and distal edges are rounded, which enables 
them to crowd easily past each other when force is 
applied. 

Q. How are their roots arranged? 

241 



242 QUIZ COMPEND 

A. The roots are flattened to the sides so that 
when pressure is brought to bear upon them they 
move with readiness over a considerable distance., 

Q. Are the incisors carried forward by the pos- 
terior column? 

A. They are not. The line of force is in straight 
lines alone. 

Q. What effect does the force produce? 

A. The force is direct upon the cuspid; meeting 
with slight resistance at the side by the incisor, they 
are carried forward. 

Q. Are local irregularities common back of the 
cuspids? 

A. They are not. 

Q. What are the most frequent forms? 

A. They occur in connection with the incisors. 

Q. Why? 

A. The teeth and jaws are not in harmony. The 
teeth of the lower jaw are forced inward by occlusion 
and the forward movement of the posterior column. 

Q. Do the two lateral arches produce common 
deformities? 

A. Like those upon the upper jaw, they are never 
alike. 

Q. What pressure is brought to bear upon the 
anterior teeth? 

A. When the second and third molars erupt the 
pressure is directed forward. 

Q. What effect does the forward movement have 
upon the teeth? 

A. Owing to the incline upon the lateral surfaces 
of the incisors, the forward movement of the cuspid 
pushes against the lateral and carries it inwards. 



ON IRREGULARITIES OF THE TEETH. 243 

Q. Do these teeth always stand in the same posi- 
tion? 

A. They do not. They stand at different angles 
depending upon the local peculiarities. Thus a 
cuspid or lateral may strike outside of its antagonist of 
the opposite jaw 

Q. When both posterior columns move forward 
what position do the incisors sometimes take? 

A. Both lateral incisors are carried inward; a 
V-shaped arch is prevented by the central coming in 
contact with the superior incisor. 

Q. What should be borne in mind in correcting 
such a deformity? 

A. If the force and mode of application be borne in 
mind, it will be understood why extremes of a lower 
lateral or central render this irregularity worse inas- 
much as they disarrange occlusion of the cuspid. 

Q. If the central stands just a little inward and 
force is applied what results? 

A. The cuspid pushes against the lateral and the 
central is carried backward. 

Q. When the inferior cuspid develops out of line 
where is it located? 

A. It is always anterior to its normal position. 

Q. Where does the cuspid usually erupt when mal- 
position of the germs takes place? 

A. Either outside of the incisor or in line with them. 

Q. What is the cause when the bicuspids are either 
outside or inside the arch? 

A. It is due to the retention of the temporary 
teeth. 

Q. What takes place when the second temporary 
molars are retained too long? 



244 QUIZ COMPEND 

Ao The first permanent molars may move forward, 
thus confining the cuspid and preventing its eruption. 

Q. Do teeth move about in the alveolar process? 

A. Yes. Where there is no occlusion or antago- 
nism, they will move up, down or laterally until they 
rest against something, it may be tooth, gum or arti- 
ficial resistance. 

Q. How is this motion best corrected? 

A. By perfect occlusion and proper relation 
between waste. and repair. 

Q. What is perfect occlusion? 

A. Each tooth is kept in place by its adjoining 
neighbor and the opposing tooth, and dislodgment is 
impossible. 

Q. Does this occlusion differ in different teeth? 

A. Yes. The upper and lower incisors over- 
lap each other, producing what is termed the over- 
bite. In the normal relation they strike in straight 
lines which pass through the roots. The teeth are 
thus held in position,, The relation of cuspids is 
similar. 

Q. What is the relation of the bicuspid and 
molars? 

A. The cusps of one tooth strike direct upon 
half of two of the opposite jaw. When one of these 
teeth are extracted, the order of the mouth is distrib- 
uted and re-arrangement of the teeth takes place. 
What this will be, depends upon a variety of circum- 
stances. 

Q. Give an example. 

A. By extraction of the first permanent molar, 
forward movement of the second molar necessarily 
follows. The tooth tilts forward. The posterior cusp 



ON IRREGULARITIES OF THE TEETH. 245 

of the first upper molar strikes the anterior cusp of 
the second lower and exerts its whole force, which 
was meant to be distributed over its entire surface. 

Q. What is understood by perfect relation between 
waste and repair? 

A. The alveolar process is a transitory structure; 
building up and tearing down of bone cells is going 
on very rapidly. This is illustrated in the eruption of 
the deciduous teeth and again in the eruption of the 
permanent and after the teeth are extracted the pro- 
cess is again absorbed away. Position of the teeth 
in the alveolar process is determined by the tissue 
about them. 

Q. What else demonstrates the deposition and 
absorption of bone cells? 

A. Pressure on a tooth in a given direction will 
remove bone cells in one direction and deposit them 
in another. 

Q. Does every tooth exert a pressure of its own? 

A, Yes. Did it not, elongation of a tooth when its 
opponent is extracted could not be accounted for. 

Q. What follows when the two fundamental laws of 
good occlusion and balanced waste and repair are vio- 
lated? 

A. Movement of individual teeth in straight lines. 
Rotation of individual teeth upon their axis and for- 
ward movement of groups of teeth. 

Q. What sometimes causes the space between the 
central incisors? 

A. It is due to a continuous growth of the suture. 
This usually begins at an early period of life and con- 
tinues until growth of the osseous system has ceased. 
Irritation is kept up by mastication. 



246 QUIZ COMPEND 

Q. May not irritation sufficient; to produce absorp- 
tion be of artificial creation? 

A. Yes. As in wedging to obtain room for filling 
teeth. Correcting irregularities of the teeth will set 
tip irritation, sometimes continuing indefinitely and 
causing a tooth or teeth to migrate. 

Q. Do the teeth of one jaw sometimes press too 
hard upon those of the other causing migration? 

A. The teeth of the lower jaw (especially the incis- 
ors) pushing against the upper centrals may cause 
them to move out of position. 

Q. What common irregularity is due to deposit of 
bone cells? 

A. That in which the inferior incisors impinge 
upon the mucous membrane of the vault. 

Q. What causes this? 

A. There is an unbalanced nervous system. There 
may be arrests of the inferior maxilla or excessive 
development of the superior. In either case excess- 
ive development of the inferior alveolar process re- 
sults, developing the incisors beyond their normal 
position. 

Q. What effect does this have upon the vault? 

A. It causes irritation of the mucous membrane, 
causing a deposition of bone cells. These carry the 
superior alveolar process and teeth forward, causing 
the teeth to protrude between the lips. This deform- 
ity is common in neurotics and degenerates. 

Q. Does the forward movement increase the spaces 
between the teeth? 

A. It does. The teeth being carried to a large 
circle the spaces between the teeth naturally en- 
large. 



ON IRREGULARITIES OF THE TEETH. 247 

Q. Does lack of functionation encourage deposi- 
tion of lime salts around tooth roots? 

A. Yes. When teeth are removed from one jaw 
the alveolar process about the teeth on the opposite 
jaw will elongate until the tooth or teeth meet resist- 
ance. 

Q. Does inflammation build up as well as tear down 
bone tissue? 

A. Inflammation due to local as well as constitu- 
tional causes may build up or absorption of tissue 
may ensue. 

Q. Is inflammation from constitutional causes likely 
to affect the alveolar process? 

A. Interstitial gingivitis therefore may set in, pro- 
ducing absorption of the alveolar process without at 
first affecting the gums. 

Q. Does infection take place? 

A. Pus infection readily results with deposit of the 
bone absorption upon the roots of the teeth. 



CHAPTER XXVIII. 



LOCAL CAUSES OF TEETH IRREGULARITIES— 
FINGER-SUCKING. 

Q. To what has the high vault been attributed? 

A. To thumb-sucking. 

Q. Can the high vault and V and saddle shaped 
arches be ascribed indiscriminately to thumb-sucking? 

A. Yes. 

Q. What is the vault shape where there is finger- 
sucking? 

A. It may be high or low. 

Q. Are the teeth and alveolar process involved? 

A. Yes. The teeth are sometimes carried out fan- 
shaped with spaces between them. 

Q. Which teeth are involved? 

A. Sometimes upon one side and sometimes upon 
the other. Sometimes those in the center are affected, 
This depends entirely upon which finger and hand and 
the position used. 

Q. How do these, deformities differ from the 
V-shaped arch? 

A. In the V-shaped arch, the teeth are crowded 
and pointed toward the center owing to the force 
applied by the posterior column and spent upon both 
halves toward the median line. The vault may or 
may not be arched. 

Q. How does it compare with the saddle arch? 

A. In saddle-shaped arches the teeth are crowded 

249 



250 QUIZ COMPEND 

(except in cases due to hypertrophy) and the teeth stand 
perpendicular. The vault may be high or low. 

Q. How are they arranged where there is thumb- 
sucking? 

A. The teeth of the inferior maxilla do not articu- 
late with the upper and are often turned inward 
which is caused by the pressure of the thumb upon 
the cutting edge. 

Q. Where are the evidences of thumb-sucking? 

A. The spreading of all or a part of the anterior 
teeth and the lower teeth are usually turned inward. 
When the vault is high the deformity may be quite 
marked in ^the anterior portion of the vault. This, 
however, is by no means characteristic. 

Q. Is the thumb-sucking habit prolonged until the 
second teeth erupt? 

A. Not as a rule. It usually terminates before 
their eruption. 

Q. How early do infants begin to suck their 
fingers? 

A. Within a few hours after birth. In a majority 
of cases not later than the first week. % The habit is 
fixed before the temporary teeth begin to erupt. 

Q. Are the alveolar process and first teeth only 
affected? 

A. If the pressure be continuous they are. 

Q. To what extent? 

A. The shape and location of the irregularity 
depends upon the hand employed, and the position of 
the thumb and finger used. The "right or left side is 
affected according to the hand used, though occasion- 
ally it is found at the median line. 

Q. Are the permanent teeth often involved? 



ON IRREGULARITIES OF THE TEETH. 251 

A. As the child usually discontinues the habit 
before the time of eruption of the permanent teeth, 
deformities produced by thumb-sucking are usually 
confined to the temporary set. 

Q. Is the superior alveolar process involved? 

A. If the child continue to suck its thumb or finger 
while the second set are erupting, arrest of the alveolar 
process will take place and the teeth will be separated. 

Q. What position do the teeth take? 

A. They take the position of the thing sucked. 

Q. Is the vault carried up by thumb-sucking? 

A. No. The high vault is not formed until all the 
second teeth are in position. It is impossible for the 
child to carry the thumb or finger the entire length 
of the vault. 



CHAPTER XXIX 



THE DEGENERATE TEETH. 

Q. What were the teeth originally? 

A; They were primitive organs of the skin which 
developed over the surface of the body. 

O. What change took place? 

A. They became dermal bones like those which 
went to form part of the skull. The placoid scales 
which were dermal teeth in the shark helped out 
deficiency of the brain case. 

Q. Why did the placoid scales or dermal teeth un- 
dergo this change? 

A. Because in vertebrate evolution the cartilagin- 
ous brain case was hardly sufficient to cover the devel- 
oping brain. 

Q. How did the teeth of sharks change the prim- 
itive method of development? 

A. Instead of developing upon the surface, the 
dermoid tissue dipped down deep into the structure 
below. 

Q. Is this a degeneration? 

A. The method of tooth formation converting 
epithelial cells without vascular supply into enamel 
was a degeneration in itself. 

Q. What takes place down in the deeper tissues? 

A. A papilla forms in the dermis which eventually 
becomes the dentine of the tooth. c 

Q. After the epidermis dips into the tissue below, 

253 



254 QUIZ COMPEND 

enlarges and adds the enamel, what becomes of the 
debris? 

A. The debris resulting therefrom as observed in 
animals and man forms degenerations or "abortive 
rudiments" of tooth succession as observed in sharks, 
some whales and reptiles. 

Q. Where does the tooth obtain its shape and 
size? 

A. From the pulp which develops deep 4°wn in 
the tissue. 

Q. Where does calcification first take place? 

A. It first takes place upon the periphery while the 
blood vessels and connective tissue recede until finally 
the root is completely formed ; only a minute opening is 
left for the passage of an artery, nerve and vein. 

Q. For what purpose are these structures? 

A. For nourishment of the pulp as well as tooth 
structure. 

Q. What is tooth formation as compared with that 
of the placoid scales? 

A. The method of formation of the tooth itself is 
a degeneration and intended for temporary use alone. 

Q. What effect do morbid states have upon the 
teeth? 

A. Diseases and traumatism which affect the 
human body as well as the embryo must necessarily 
affect structures so poorly nourished as the teeth and 
their germs. 

Q. What takes place in the evolution of the alve- 
olar process? 

A. Change in the shape of the alveolar process, 
neglect of hygiene causes interstitial gingivitis and 
endarteritis obliterans (thus preventing circulation 



ON IRREGULARITIES OF THE TEETH. 255 

and nourishment of the teeth) and removes resistance, 
thus furnishing a suitable medium for micro-organ- 
isms. 

Q. What are some marked degenerations of the 
enamel? 

A. Interglobular spaces and enamel defective in 
quality and quantity. 

Q, Is tooth decay degeneration? 
. A. Tooth decay is a marked degeneration, but 
sometimes a normal process (normal senility) for the 
carrying out of which osteomalaciary methods are 
provided. 

Q. In what animals are the teeth continuous? 

A. In polyphyodont (continuous tooth) animals, 
the teeth come and go. Periods of stress are not in- 
volved in individual teeth. 

Q. How is it in man? 

A. Tooth degeneration is normally a continuous 
one, and since man has only two sets, they undergo 
degeneration through the periods of stress. 

O. How many teeth has man? 

A. At his present stage of evolution he has twenty 
in the temporary and thirty-two in the permanent set. 

Q. If there is any deviation in these numbers at 
what period must it take place? 

A. Any change in number is the result of embry- 
onic change occurring between the sixth and fifteenth 
week for the temporary set and the fifteenth week 
and birth for the permanent set. 

Q. When teeth erupt late in life what are they 
called? 

A. They are called third sets. 

Q. Are they third sets? 



256 QUIZ COMPEND 

A. Properly not, because the germs must devel- 
op with those of the other sets. 

Q. Why are they so tardy in eruption? 

A. For want of dynamic force to propel them 
into place. 

Q. Are they ever obstructed or mal-imposed? 

A. They are frequently misplaced in the jaw, and 
again they are frequently held in the jaw by the other 
set. . 

O. What does it denote when there are more than 
twenty in the temporary or thirty-two in the perma- 
nent set? 

A. Atavism. 

O. When did man reach his highest physical 
development? 

A. When well developed jaws held twenty tempo- 
rary and thirty-two permanent teeth. 

Q. When there is a decrease in number what does 
it mean? 

A. Decrease in number from the dental stand- 
point means degeneracy of the jaws and teeth. 

Q. What does such jaw and tooth ' degeneracy 
mean? 

A. It means a marked advance in the man's evo- 
lution as a complete being. 

Q. What was the dental formula of most general- 
ized primate? 

A. In the New Mexican lower"eocene occur a few 
representatives of the lowest primate, such as the 
lemurarius and limnotherum, each the type of a dis- 
tinct family. The lemurarius most nearly allied to 
the lemurs is the most generalized primate yet found. 



ON IRREGULARITIES OF THE TEETH. 257 

It had forty-four teeth in continuous series above 
and below. 

Q. What do supernumerary teeth indicate? 

A. An atavism which demonstrates that man dur- 
ing his evolution from the lowest primates has lost 
twelve teeth. 

Q. How many forms do supernumerary teeth 
assume? 

A. Two. They either resemble adjoining teeth 
or are cone-shaped. They rarely are exactly counter- 
parts. Each tooth may be duplicated. 

Q. What shape do teeth that fail to approximate 
normal neighbors assume? 

A. They always assume the cone-shape of the 
primitive tooth. 

Q. Where are supernumerary teeth usually located 
in the mouth, and what significance has this? 

A. In a majority of cases either in the extreme 
anterior or posterior part of the mouth. This dem- 
onstrates that the teeth resemble in number those of 
the primates and that they have been dropped off at 
either end of the jaw. 

Q. Do they occur elsewhere? 

A. Yes, but. when present they are not usually 
cone-shaped but take normal shapes. 

Q. What is indicated by the fact that the cone- 
shaped tooth as a rule is perfect in construction? 

A. It is of much value in outlining tooth and jaw 
evolution, especially from degeneracy aspects. 

Q. What is taking place in the evolution of the 
jaw? 

A. It is shortening in both directions. 

Q. How long will this shortening continue? 



258 QUIZ COMPEND 

A. So long as the jaw must be adjusted to a vary- 
ing environment. 

Q. What shows that the jaw is undergoing trans- 
ition? 

A. The jaw of man originally contained more 
teeth than at present. Lack of adjustment to environ- 
ment produces from the shortening, degeneracy of the 
jaws and atavism of the teeth. 

Q. What does this indicate? 

A. While degeneracy of the jaws indicates general 
advance it also demonstrates that man is not yet 
adjusted to his new environment. 

Q. What does shortening of the jaw cause? 

A. It causes supernumerary cone-shaped teeth to 
erupt in mass at the extreme ends of the jaw. 

Q. Are cone-shaped teeth often seen on the lower 
jaw? 

A. No. Mobility of the lower jaw prevents mal- 
adjustment to environment present in the upper. 

Q. What effect has shortening upon the third 
molars? 

A. It causes them to be so wedged in between the 
angle of the jaw and the second molar that eruption is 
impossible. It may tip forward and strike the second 
molar in an abnormal position or it may be missing 
altogether. 

Q. What per cent, are missing? 

A. In 670 patients forty-six per cent. 

Q. From the shortening of the mal-adjustment and 
disappearance, what inference results as to this tooth? 

A. This tooth seems destined to disappear. 

Q. Is it more often absent upon the upper than 
the lower? 



ON IRREGULARITIES OF THE TEETH. 259 

A. Yes. 

Q. When it is absent, what general conditions 
exist? 

A. The jaw is small and teeth irregularities are 
frequent, nasal stenosis, nasal bone and mucous mem- 
brane hypertrophy, adenoids and eye disorders co-exist. 

Q: After the third molar which tooth is next des- 
tined to disappear? 

A. The lateral incisor. 

Q. What per cent, are lost? 

A. Of 670 persons, fourteen^per cent, were miss- 
ing. 

Q. How many laterals have the lower mammals? 

A. Two laterals, and the other is destined to dis- 
appear. 

Q. Are other teeth sometimes missing? 

A. In degenerates, it is not uncommon to find 
centrals, cuspids, biscuspids and even molars miss- 
ing. In markedly degenerate jaws, second as well as 
third molars are frequently absent. 

Q. What do missing teeth indicate? 

A. Lack of development of germs, due to either 
heredity or defective maternal nutrition at the time of 
conception or during early pregnancy. 

Q. What teeth tend to conation? 

A. Crescent-shape bitubercular, tritubercular as 
well as deformed teeth tend to the cone-shape. 

Q. Why do these malformations take place? 

A. They result from pre-congenital trophic 
changes in dentine development. 

Q. In what does it consist? 

A. In dwarfing and notching the [cutting and 
grinding edges of the second set of teeth. 



260 QUIZ COMPEND 

Q. What is one of the marked deformities of the 
teeth? 

A. Hutchinson's teeth. Because Hutchinson first 
described them in connection with syphilis. 

Q. What are Hutchinson's teeth? 

A. They consist of incisors drawn together (cone- 
shape) at the edges and hollowed out at the center. 

Q, Are these teeth pathognomonic of syphilis? 

A. They are not without other diagnostic signs. 
They alone would not decide a case of lues. 

Q. Did Hutchinson claim that these teeth were 
pathognomonic? 

A. No. He admits that in at least one-tenth the 
cases luetic etiology could be excluded. Lues only 
plays the part of a diathetic state profoundly affecting 
the material constitution at the time of dentine and 
enamel development. 

Q. Are these marked deformities of the teeth due 
to other causes than lues? 

A. Yes. Any marked constitutional disturbance 
such as scarlet fever, typhoid fever, pneumonia, etc. , 
will produce like results. 

Q. What do these teeth resemble from an atavistic 
standpoint? 

A. The coincidence in form between Hutchinson's 
and malformed teeth and those of. the chameleon, 
demonstrate that tropho-neurotic changes produce 
atavistic teeth. 

Q. Do all teetlusometimes conate? 

A. In marked forms of degeneracy, the teeth upon 
both upper and lower jaws will sometimes conate. 

Q. In the evolution of the teeth, what theories 
have been advanced? 



ON IRREGULARITIES OF THE TEETH. 261 

A. Two. The differentiation and concrescence 
theories. 

Q. Who advanced these theories? 

A. The first was advanced by Osborn and Cope 
in America; the second by Magitot in 1877, and later 
by Schwal'be, Carl Rosa, and Kurkenthal. 

Q. What is the differentiation theory? 

A. In the triassic period, the first mammals pos- 
sessed conical, round, reptilian or dolphin-like teeth. 
Some aberrant types had complex multitubercular 
teeth. Descending the scale, cusps were added here 
and there forming a triangle. In the primitive carni- 
vore miacis, a heel is found which from the grinding 
surface seems to have spread out broad as the trian- 
gle. The three molars in this animal show that the 
anterior triangular portion of the crown has been 
simply leveled down to the posterior portion of the 
crown. In this way the human molar tooth with its 
low quadritubular crowns has evolved by addition of 
cusps and by a gradual modeling from a high 
crowned, simple, pointed tooth. By this budding all 
the teeth are developed. 

Q. What is the concrescence theory?/ 

A. Cone teeth placed as they lie in the jaw 
of the whale, would represent primitive denti- 
tion. In the course of time a number of these teeth 
become so clustered together as to form two cusps of 
a bicuspid and four cusps of a human molar. Each 
one of the whale tooth points takes the place of one of 
the cusps of the mammalian tooth. In other words by 
concrescence, four teeth are so brought into one as 

to constitute the four cusps of the molar crown. 
21 



262 QUIZ COMPEND 

Q. From the degeneracy standpoint which of 
these theories seems to be correct? 

A. In degenerate jaws both the differentiation 
and concrescence theory are beautifully illustrated. 
From an atavistic standpoint every tooth in the jaw at 
one point or another may display rudimentary cusps. 
Teeth are found joined together quite frequently, 
especially in the anterior and posterior part of the 
mouth. Thompson remarks that there is a graduation 
from central incisors towards the bicuspids ia evolu- 
tion. 

Q. Is this graduation observed from cuspid to 
bicuspid in man? 

A. The general opinion is that it is not. There 
are indications, however, of an inner cusp or cingu- 
lum that often presents itself in bicuspid form in the 
lower mammals, like the mole and that the first pre- 
molar or bicuspid is then more caniniform. 

Q. Is the rudimentary cingulum or inner cusp 
seen in man? 

A. They are, although variable and erratic as to 
position. The condition appears in degenerates as far 
front as the centrals and is often present on the lin- 
gual face of laterals and cuspids of man. 

Q. Is not the lingual cusp of the inferior bicuspids 
often fully developed? 

A. Yes. 

Q. Is it quite deficient in some lower apes and 
semi-apes? 

A. Yes. Especially in the lemurs. 

Q. When does it attain its highest development? 

A. In the anthropoids and in man. 

Q. Are the changes noted by Osbofn in the level- 



ON IRREGULARITIES OF THE TEETH. 263 

ing of the cusps to form the molar ever observed in 
man? 

A. Yes. In marked degenerates. 

Q. Do indications of the concrescence theor) r 
occur in the tooth types of man? 

•A. Yes. It is not uncommon to find incisors and 
cuspids with two roots, bicuspids with two or three 
roots and molars, especially the third, with three, four, 
five and six showing an atavistic tendency. 

Q. Are there other evidences of atavism in the 
molar teeth? 

A. Yes. Dr. S. H. Guilford first called attention 
to 4 'compressed or flattened crowns," as later did Dr. 
W. B. Pearsoll of Dublin, Ireland. 

Q. Are they frequently seen? 

A. They are very common in arrested and degen- 
erate jaws. 

Q. Which teeth are involved? 

A. Always the last one. If the third molar is in 
place, it is the tooth, if it is missing then the second 
molar. 

Q. What position do they take? 

A. The crowns and roots seem to retain the orig- 
inal "triconodont" type with cusps and roots in line. 

O. Are the roots close together or separated? 

A. The roots are sometimes separated containing 
two or three, or these may be flattened upon the sides 
with a number of markedly deformed pulp canals. 

Q. What other anomalies are observed in degen- 
erate jaws? 

A. Through the operation of the law of economy 
of growth, producing arrest and excessive development, 
edentulousness and excessive dentition occur. 



264 QUIZ, COMPEXD 

Q. What did Darwin find as to hair and teeth? 

A. That hairless dogs have imperfect teeth. 
Here the dermic defects affected the animal as a 
whole, other organs profiting by the deficiency of hair 
and teeth. 

Q. What did Magi tot determine? 

A. That in most cases of hairy men, there is de- 
fective or irregular dentition. 

Q. What did Thurman report? 

A. The case of a man fifty-eight years of age who 
was almost devoid of hair. All his life he possessed 
only four teeth. His skin was delicate. There was 
absence of sensible perspiration and tears. 

Q. What did Williams report? 

A. The case of a fifteen-year-old girl who had 
scarcely any eyebrows or hair on head and who was 
destitute of eyelashes. She was edentulous and had 
never sensibly perspired. 

Q. Are there cases on record with few or no teeth? 

A. Yes. Fox reports a woman who had but 
four teeth in both jaws. Tomes cites several similar 
instances. Hutchinson reports a child who was per- 
fectly edentulous as to temporary teeth, but whose 
permanent teeth duly and fully erupted. Guilford 
describes a man of forty-eight years congenitally and 
permanently edentulous who had no sense of smell 
and almost without taste. The surface of the body 
was covered with fine hair. He had never visibly per- 
spired. Otto observed two brothers who were eden- 
tulous. 

Q. How does excessive dentition show itself? 

A. In many varieties. Those which constitute a 
return to the polyphyodontia of the lower vertebrates. 



ON IRREGULARITIES OF THE TEETH, 265 

Q. State some of these. 

A. O. Hildebrand of Gottingen, Germany, in 1889 
reported a case of a child of twelve which after various 
operations had been relieved of about two hundred 
teeth of various sizes. Two years later (July, 1891) 
at the Surgical Clinic, it was found that both sides of 
the lower jaw were much thickened and also the right 
upper. There were found seventeen teeth, part of 
them normally developed, others in an undeveloped 
condition. The position was irregular. From the 
upper and lower jaw there w T ere again some masses of 
teeth removed which represented about one hundred 
and fifteen. There were also found two glassy bodies 
_about the size of two peas which under the microscope 
showed tooth structure. 

Q. What does this indicate? 

A. Return to the polyphyodontia from arrest of 
development very early in foetal life. 

Q. Are there other illustrations of polyphyodontia? 

A. Yes. In the Paris Dental School Museum are 
several milk teeth both of the superior and inferior 
maxilla fused together. Black cites a case where 
there were two rows of teeth in the superior maxilla. 
Hellwig has observed three rows of teeth. The 
ephemerides contain an account of a similar anomaly. 

Q. Are teeth found about the head elsewhere 
than in the mouth? 

A. Yes. Gould points out that teeth have been 
found in the nose, orbit, palate, and exceptionally, as 
in a case reported by Carver, they may grow r from the 
lower eyelids. Arrest of development proceeding 
from checked development at the senile period of 
foetal life may evince itself in senility of the alveolar 



206 QUIZ COMPEND 

process, as in the case reported by Bronzet where a 
child of twelve had but half its teeth, the alveolar 
process having receded as in old age. 

Q. Do not arrests of development produce poly- 
phyodont conditions in man? 

A. Yes. Catching reports the case of a girl who 
had all her teeth at six months and shed them at nine. 
At fifteen months she had a full set once more. In 
six weeks thereafter these were shed. At' thirty 
months she had a full set again, which remained until 
her fourth year, when came another set. These 
remained until another set began to erupt at eleven 
and became the permanent set at fifteen. 

Q. Is there a relationship between dental and 
dermal tissues? 

A. E)r. A. H. Thompson points out that these 
structures are governed by the same laws, subject to 
the same influences and possess the same phenomena 
of character as allied tissues. The relationship and 
homology of the teeth with the derm and its varied 
appendicular productions are established by demon- 
stration. Teeth, spines, scales, dermal plates, feathers, 
hair, nails, bristles, horn, hoof, etc., varying in form 
and apparent purpose as much as tissue can well 
attain, are very closely related in structure and func- 
tion. 

Q. Of what does the enamel consist? 

A. It consists of decalcified epithelium cells elab- 
orated from the endurance of an appointed work and 
service in the economy. 

Q. What else does it possess? 

A. Enamel like the epithelium and all corneous 
structures yields keratin. 



ON. IRREGULARITIES OF THE TEETH 267 

Q. What would result from this under certain con- 
ditions? 

A, In such unstable structures in evolution as the 
teeth, arrest of development would produce for this 
reason horny structures in place of enamel. This 
occurs physiologically. In the oviparous mammal the 
duck-bill, true teeth appear in the embryonic state to 
give way later by what Thompson calls suppressive 
economy or the degenerative results of the struggle 
for existence between the organ to horny structure. 
Irregular enamel is found normally in wombats. 

Q. What other instances may be cited? 

A. Those of the toothed birds of the tertiary. 

Q. Do these conditions exist in man? 

A. In neurotics and degenerates, arrest of devel- 
opment occurs, hence very little or no enamel upon 
the teeth. 



CHAPTER XXX. 



SURGICAL DIAGNOSIS. 

Q. What is necessary to a successful result in 
treatment? 

A. Knowledge of the origin of disease as well 
as of the symptoms. 

O. What happens when the symptoms are removed 
without ascertaining the cause? 

A. Treatment fails utterly in the main object, the 
removal or amelioration of the 'disorder. 

Q. Should the dentist go outside the mouth if 
necessary to find the origin of the disorder? 

A. The dentist should be trained to seek the cause 
wherever it may be. 

O. Will general examination of the face and jaws 
show the character of the deformity? 

A. The contour of the face, the facial angle and 
general appearance will often decide the extent and 
character; whether there be a V or saddle arch, ex- 
cessively developed alveolar process or an underhung 
jaw. 

Q. What is the first principle a dentist should 
adopt? 

A. He should learn what constitutes a normal 
face in a given individual or nationality. 

Q. Do nationalities differ as to shape and contour 
of the face? 

A. Most decidedly. The dentist should see the 

269 



270 QUIZ COMPEND 

jaw has a normal outline or belongs to the V or saddle- 
shaped variety. 

Q. What other structures are involved? 

A. The vault and alveolar process and the occlusion 
(let the patient open and close the mouth slowly). 
The beginner should familiarize himself with tooth 
individuality as to class, outline and occlusion. 

Q. What takes place with asymmetry of the upper 
and lower jaws? 

A. Occlusion from the cuspid back is ^usually 
wrong. In such cases the upper cuspid generally 
strikes in front of the lower cuspid instead of between 
it and the bicuspid disarranging the articulation of 
every tooth. 

Q. Is the difficulty in local irregularities easily 
detected? 

A. Yes. It is either found in the alveolar arch or 
the malposition of the individual tooth. 

Q. What would be the first inquiry? 

A. The family history. It has been claimed that 
it is useless to try to correct an irregularity due to 
family type. That the type returns despite long 
continued efforts. This is an error. Especially in 
this country from change in climate and intermar- 
riage do shapes of heads, faces, and jaws pass from 
one extreme to the other in four generations. Evolu- 
tion in face and jaw goes on so rapidly that the tissues 
are too unstable to present fixed forms. 

Q. Is there a family type? 

A. No, while the child may inherit a family type 
of face still irregularities cannot be said to be inherited 
since the order and manner of their eruption and 



ON IRREGULARITIES OF THE TEETH. 271 

position are purely mechanical and the influence of 
environment comes into play. 

Q. Can the character of the jaw and irregularities 
of the teeth always be settled? 

A, No. It is often well to wait until the patient is 
of an age when the permanent type can be determined. 

Q. Why? 

A. Correction of tooth irregularities before that 
period often gives unsatisfactory results. 

Q. Can all cases be benefited? 

A. If taken in time all cases may be made less 
unsightly. 

Q. What will assist such operations? 

A. Knowledge of evolution and of its reverse phase, 
degeneration, as w r ell as of heredity and atavism, 
are necessary factors in the skill of the operator. 

Q. Before operating, what should be done? 

A. A study of the models should be made. In prog- 
nosis, extent of deformity must be taken into consid- 
eration. 

Q. Will not many cases correct themselves? 

A. Cuspids and bicuspids not infrequently erupt 
out of position but gradually find their proper places. 
Deformities during second dentition are common, 
while some deciduous teeth remain in the mouth. 
These often right themselves. 

Q. Should the operator state absolutely to the 
patient or parent the ease or difficulty of correction or 
time required? 

A. No. Many cases which seemingly present no 
difficulty often give much trouble since the resistance 
cannot be determined. 

Q. Should a case be hurried? 



272 QUIZ COMPEND 

A. It should not. Time spent in careful examina- 
tion of the case is well spent. Haste here, as else- 
where, makes waste. 

Q. What must be studied? 

A. Every particular. The operator must forecast 
in his mind appliances to be used, the different steps 
to be taken and time required before prognosis can be 
given with approximate exactness. 

Q. What is the best time to regulate teeth? 

A. This win depend upon the nature of the* irreg- 
ularity. Approximately from the twelfth to the 
fourteenth }^ear. 

Q. Is not this a very critical period in the life of 
the individual? 

A. It is. It is one of the periods of stress and the 
period most impressible in the growth of the individ- 
ual. The transitional period between childhood and 
puberty. 

Q. Why then select this time? 

A. Because all the teeth are erupted, general nutri- 
tion is most active, the osseous system is in the construc- 
tive stage and formative processes are in operation. 
The roots of the teeth are not fully developed and are 
more or less loosely confined in the alveoli. The 
apical foramina are large, which lessens liability of 
blood supply, impairment, and consequent destruction 
of the pulp. 

Q. What are the chances of good results after that 
period? 

A. Chances of success in regulating decrease 
yearly after puberty and after twenty-six are very 
meager. In a majority of cases, the osseous system 
is fully developed at this period. 



ON IRREGULARITIES OF THE TEETH. 273 

O. Is it possible to regulate deformities as late as 
the thirtieth year? 

A. It sometimes can be done. The resulting pain 
is, however, so severe and the mechanical force neces- 
sary to produce absorption of the alveoli so great that 
the results hardly justify the procedure. 

Q. When regulated so late in life, is ossific material 
easily deposited to hold the teeth? 

A. It is not. Corrective plates must be worn 
sometimes for years before they become strong. 

Q. When teeth are regulated late in life, especially 
when extensive operations are performed, is there 
ever a compensating ossific deposit? 

A. In such cases the inflammatory process is 
almost never restored. Chronic inflammation of the 
alveolar process and peridental membrane (a veritable 
interstitial gingivitis) sets in with excessive absorp- 
tion of the alveolar process and gum contraction. 

Q. What precaution should be taken if teeth must 
be regulated late? 

A. The patient should be impressed with a doubt- 
ful prognosis. It must be remembered that the 
alveolar process is a transitory structure. It is simply 
to hold the teeth in place. It is removed when the 
teeth are extracted or from too violent irritation 
(auto-intoxication or senile absorption). Hence the 
older the patient the less liable to restoration. 

Q. What should be done if the patient insist? 

A. The patient must assume the responsibility of 
failure. 

Q. How does the process of repair after regulation 
differ from repair of frac:ure? 

A. In the osseous system two parts of homogene- 



274 QUIZ COMPEND 

ous structure are united. In repair of regulation, the 
tooth root, a dense structure, is enclosed in a spongy 
structure, the alveolus. There is no bony union. 

Q. Is alveolar nutrition very active? 

A. It is during first and second dentition until the 
roots are perfectly formed or until the final growth of 
the alveolar process. 

Q. What happens afterward? 

A. The blood supply being less, waste and repair 
do not go on so rapidly when the alveolar process is 
injured. 

Q. How is lowered nutrition sometimes shown? 

A. In the separation of the teeth and recession of 
the alveolar process and gums in rapid wedging, as 
well as in interstitial gingivitis. 

Q. What illustrates the difference between fracture 
in bone and tooth movement? 

A. The fact that the attachment of a tooth to the 
alveolus later in life cannot be compared to the union 
of a fractured bone is evident in the aptitude of teeth 
when regulated to return to their original place. 

Q. Is new tissue as strong as the original? 

A. Unlike bone and cicatricial tissue it is not as 
strong as the original. 

Q. In undertaking regulation should the general 
health be taken into consideration? 

A. It should; as the majority of cases are in youth, 
the state of general health is of no slight importance. 
The most favorable period for operation is unfortun- 
ately one of the most critical in the life of the patient. 

Q. What are the dangers? 

A. From the age of twelve, the beginning of one 
of the most important periods of stress, the rapidly 



ON IRREGULARITIES OF THE TEETH. 275 

growing boy or girl is subject to many marked phys- 
ical changes entailing profound disturbances of the 
tropho-nervous system. 

Q.. What other conditions are liable to cause dis- 
turbance? 

A. Prolonged and injudicious worry, over study, 
over exertion, impure air, improper food, sexual irri- 
tation, auto-intoxication, as well as other disturbing 
factors tend to become prominent in the life of the 
individual. 

Q. What is the strongest factor at this period? 

A. Sexual disturbance is of special importance on 
account of the periods of stress. When to physiologic 
perturbation of this important period of evolution are 
added influence of environment, perversions of nutri- 
tion like rachitis and allied states consequent upon 
congenital weakness, improper dietetics, hereditary 
syphilis or the exanthemata, the necessity of taking 
into account the influence of the general health upon 
operative procedure is self evident. 

Q. Under such conditions what is best to do? 

A. Operations upon young persons in delicate 
health should not be done until the constitution has 
improved. 

Q. Should the dentist be able to recognize these 
conditions? 

A. He should possess a general knowledge of med- 
icine so that he can recognize any physical defect and 
have it properly treated. 

O. What is the general condition of all children 
who require this kind of treatment? 

A. They are children with unstable nervous sys- 



276 QUIZ COMPEND 

tems and whose physical development is a departure 
from the normal. 

Q. What are some of the disturbances? 

A. The mucous membranes are badly developed, 
especially bowels, rectum, and other mucous tracts. 
The digestive and assimilative functions are faulty, 
The glandular system is weak. The excreta are not 
properly eliminated. From an undeveloped nervous 
system, strain at this period is often attended with 
disastrous results. 

Q. What is the process of absorption? 

A. It was thought that when mild pressure was 
applied this was physiologic, now it is known to be 
pathologic. 

Q. Explain this. 

A. When pressure is applied, irritation and pressure 
set up inflammation which is interstitial in character. 
Inflammation causes deposition of lime salts just as it 
does in fracture. 

Q. What effect do extensive operations or rapid 
movement of the teeth have upon the alveolar process? 

A. Not infrequently in such patients later in life it 
is found that the alveolar process is not restored. 
Interstitial gingivitis sets in ea^ly, the trabecule are 
destroyed, the teeth loosen, separate or crowd together, 
elongate and are finally lost. 

Q. What is the character of the patient who usually 
requires dental regulation? 

A. They are generally neuropaths and degenerates. 
This increases the danger from careless procedure. 

Q. How should the patient be treated? 

A. His assimilation must be normal. He must 
have enough unstimulating food to suit the particu- 






ON IRREGULARITIES OF THE TEETH. 277 

lar case. He should have abundance of sleep in a 
well-ventilated room. He should be in the open air 
as much as possible. The mind should be placid and 
agreeably occupied so as to aid him to forget the irri- 
tation during the process. 

Q. Does irritation with absence of pain affect the 
nervous system? 

A. It does. Irritation without physiologic re- 
sponse is a greater tax on the nervous system than 
pain itself. 

Q. Should dentists therefore be satisfied that every- 
thing is going well if the patient does not complain? 

A.. They should not. They should encourage the 
patient to give expression to his feelings. This aids 
in deciding the time required for each step. 

Q. Should the patient go to school while under 
treatment? 

A. This will depend upon the patient. School 
strain to some children is a tax in itself. Therefore, 
it may be necessary to take the patient out of school 
or to diminish his task. Schools are badly ventilated. 
Exercise during school hours is almost impossible. 

Q. Is not school-room discipline detrimental to 
some children? 

A. Routine discipline of the school-room added to 
strain of regulation is detrimental to health and 
spirits when multiplied by the other cares of puberty 
and adolescence. 

Q. Is not the mind in a morbid state during 
puberty? 

A. Children during puberty and adolescence are 
morbidly conscientious, ambitious, and reserved. 
They suffer much and say little. This is particularly 



278 QUIZ COMPEND 

true of girls who do not find the relief boys dp in out- 
door play. 

Q. Is not more care required of girls? 

A. Her life is more circumscribed and she is more 
liable to passive suffering. 

Q. Should co-operation of a skillful physician be 
secured as to the general welfare and as a share of the 
responsibility? 

A.. Yes. Cases occur where girls are invalided for 
years solely by shock to a primarily unstable nervous 
system from prolonged operations in regulation. 

Q. What should be done before such an operation? 

A. The patient should be weighed at the time the 
appliances are adjusted and noted every two weeks 
throughout the operation. 

Q. What is necessary on the part of the oper- 
ator? 

A. Knowledge of human nature, quick, judicious 
sympathy, an agreeable presence and tact are very 
essential. If the dentist work in harmony with the 
laws of mental and physical health, half is gained. 

Q. Are people anxious to have their teeth reg- 
ulated? 

A. This depends somewhat upon the social status 
of the patient, sex, and age. People not well-to-do 
even if they have a decided aesthetic sense are so 
hampered with pecuniary consideration of a more 
urgent nature that little attention is paid to irregu- 
larity. 

Q. How do those in better circumstances look upon 
such operations? 

A. Life assumes large proportions. Their lot in 
life may be materially changed by an attractive mouth. 



ON IRREGULARITIES. OF THE TEETH. 279 

Beauty is of the greatest importance. Society taking 
these things for granted acts upon them. 

Q. Are operations more likely to be performed 
upon the well-to-do than upon the poorer? 

A. Such children seek the dentist for relief. 
Mothers usually are alive to the appearance of then- 
children and encourage them to endure the strain. 

Q. Are parents likely to hinder results by indiffer- 
ence or careless remarks?* 

A. Frequently they do not co-operate by enforcing 
wearing of appliances and regular visits. The dentist 
should determine the attitude of parents before his 
task is undertaken since without their. co-operation his 
best efforts will be thwarted and his reputation suffer. 

Q. What is the first step jn regulation? 

A.. Taking the impression of the mouth. 
. Q. Why? 

A. The position of the teeth, their relation to one 
another and the conformation of the jaws can be more 
easily studied, and an accurate conclusion more readily 
deduced. 

Q. What is necessary in such operations? 

A. Teeth should not only be moved to their proper 
places but must be in harmonious relation to one 
another. 

Q. What occurs if they be not in harmony? 

A. They tend to return to their faulty position. 
Their normal relation can best be determined by 
■studying the model. 

Q. What material should be employed in taking 
impressions? 

A. The material depends upon the shape of the 
jaws and position of the teeth; if the teeth are but 



280 QUIZ COMPEND 

slightly irregular and the crowns short, plaster of 
Paris should be used. On the other hand, if the teeth 
are irregular and long and the arch deep, plaster of 
Paris will be likely to adhere to the teeth. In such 
cases modeling compound should be used. 

O. How should the patient sit to have an impres- 
sion taken? 

A. He should sit low in the operating chair or in 
an ordinary chair. The operator can thus better con- 
trol the patient. 

Q, How should the clothing of the patient be pro- 
tected? 

A. By placing two towels under the chin, one fas- 
tened to the clothing, the other loose, and a newspaper 
in the lap. 

Q. How should the impression cup be prepared? 

A. One should be selected large enough to enclose 
the teeth. This should be built up with wax so that it 
will extend beyond the margin of the gum. The cen- 
ter of the cup should be filled with soft wax to conform 
to the vault. In this way the plaster will be carried 
to all parts of the mouth. 

Q. What is the next step? 

A. Plaster should be mixed in a bowl with suffic- 
ient water to make mixture of the consistency of 
cream; add a little salt to hasten the process of set- 
ting. After stirring until the air bubbles have disap- 
peared and the plaster has begun to set, the cup and 
outer edge should be filled. 

Q. How should this be applied to the mouth? 

A. The operator should shmd to the right and just 
behind the patient with his left arm around the left 
side of the head and the fore finger inserted into the 



ON IRREGULARITIES OF THE TEETH, 281 

mouth. The cup should be carried to the mouth with 
the thumb and fore finger upon the handle and the 
middle finger in the center to steady it. After it has 
been inserted into the mouth with a rotary motion of 
the right hand it should be pressed up into place with 
the middle finger. At the same time the lips should 
be raised, the cheek pressed out with the left fingers. 
When the cup is in position it should be held firmly 
with the middle finger in the center of the plate against 
the teeth. The head should be inclined toward the 
breast to prevent the plaster's passing back to the 
fauces. 

Q. What is to be done if the stomach become dis- 
turbed? 

A. By holding the fingers in the center of the cup 
as suggested, the contents of the stomach can be 
evacuated without interfering with the impression. 

Q. When is the impression ready to be removed? 

A. Test the plaster in the bowl or upon the side- 
of the cup; when it breaks with a clean fracture, it is 
time to remove the cup. 

Q. What should be done with it? 

A. It should be placed in the outer towel held by 
the assistant. Carefully examine the mouth and if 
pieces of plaster are seen, put them into the towel on 
the proper side of the impression, afterwards arrang- 
ing the pieces in the proper places. 

Q. What is the second towel for?' 

A. It is for the purpose of removing plaster that 
may remain about the face. 

Q. Should the operation be explained to the patient? 

A. It is well so to do. Otherwise the patient 
might anticipate serious experience. 



282 QUIZ COMPEND 

Q. Are such details necessary? 

A. The slightest detail should be so strictly attended 
to as to insure perfect impressions. 

Q. In taking an impression of the lower jaw, how 
should the patient sit? 

A. He should sit higher so that the mouth will be 
on a level with the elbow of the operator who stands in 
front of the patient. 

Q. How is the tray for the lower jaw manipulated? 

A. The fingers of the left hand should push out the 
cheek and lips while the cup is rotated into place with 
the right hand. The first and second fingers of each 
hand should rest upon the cup over the bicuspids and 
molars, the thumbs under the jaw on either side, thus 
holding the cup firmly in place until the plaster sets, 
which should be removed and placed in the towel as 
before. 

Q. What is the next procedure? 

A. After a few minutes' hardening the impression 
should be placed under running water to remove 
mucus, saliva, blood, or particles of plaster. Should 
the plaster be broken the pieces can be placed in posi- 
tion indicated by the arrangement on the towel, and 
when perfectly dry fastened together with melted 
wax. 

Q. How is the model separated from the impression? 

A. A clean separation of the model is obtained by 
covering the impression with a lather of soap and 
washing off the surplus, or by coating the surface with 
shellac and oiling to prevent sticking. 

Q. How is modeling compound used? 

A. Place boiling water in a bowl and dip the com- 
pound into it until it is soft enough to use. 



ON IRREGULARITIES OF THE TEETH. 283 

Q. How should it be applied ? 

A. Place a sufficient quantity into the impression 
cup and proceed as with plaster, cooling it off with 
cold water applied with a napkin. 

Q. How are the models obtained? 

A. Mix the plaster the consistency of cream. Place 
a few drops of water in the cavities made by the teeth 
to exclude the air, when the plaster is introduced tap 
the cup on the bench, thus driving out all the air, build 
up the plaster to make body for the model. Such 
models had better stand from twelve to twenty-four 
hours so that they may be perfectly hardened. 

Q. What should be done with them after removal? 

A. Trim the model roughly. After articulation 
trim it so that the body of the model will be parallel 
with the line of the teeth and made presentable for 
inspection. 

Q. How should the models be marked? 

A. Place the name of the patient and the date of 
beginning operation upon the surface of the lower 
model and the patient's initials upon the upper. The 
surface should now be varnished; an elastic band will 
hold them together. 

Q. Could they not be placed upon the articul- 
ator? 

A. A wire articulator may be used to a good 
advantage at little expense. 

Q. What should be done with the models? 

A. They should be placed conveniently so as to 
improve spare moments by studying physiologic con- 
ditions of the teeth before arriving at conclusions as to 
the pathology of the case. 

Q. What is necessary? 



284 QUIZ COMPEND 

A. In determining the character and extent of a 
deformity a criterion is necessary. 

Q. How would a standard be obtained? 

A. In the skull on taking the two cuspids for a start- 
ing point, the arc of a circle is found on dropping a line 
from one cusp of the cuspid to the center of the third 
molar, the posterior part is seen to diverge consider- 
ably from the central line, The inferior incisor should 
close inside of the superior incisor.- The buccal cusps 
of the bicuspids and molars should occlude at the cen- 
ter line or sulci of the superior bicuspid and molar. 

Q, What should be the curve of the teeth from the 
side? 

A. It should be a gentle curve downwards from 
the cuspid to the second bicuspid rising until the third 
molars are reached. 

Q. How should the teeth lock? 

A. The superior cuspid should stand at the point of 
occlusion of the inferior cuspid and first bicuspid. If 
the teeth are all in position, each tooth will lock 
between two teeth of the opposite jaw. The median 
line of the upper incisors should correspond with the 
median line of the lower incisors. 

Q. What is to be done if the irregularity is compli- 
cated and more room is required? 

A, It is best to enlarge the arch. The changing 
of a well articulated set of teeth so that the cusps of 
the opposite will strike is an unpardonable error. 

Q. What should be the size of the arch? 

A. The arch of the superior and inferior maxilla 
should have a diameter of sufficient width to prevent 
an impression of the teeth on the sides of the tongue 
or as large as the jaws will admit. Any deviation of 



ON IRREGULARITIES OF THE TEETH. 285 

the jaws and teeth from this outline is a deformity 
which should receive the attention of the dentist. 

Q. What do the models reveal with' this standard 
in mind? 

A. Careful consideration shows that one of two 
conditions exists, either the teeth are in a crowded 
and irregular condition inside of the proper line or 
they are isolated and irregular outside. 

Q. What teeth are almost always involved? 

A. In a majority the irregularity involves the teeth 
anterior to the first permanent molar. 

Q. What arises under such conditions? 

A. Whether to enlarge the arch by force or to 
extract one or more teeth. 

Q. What will decide this? 

A. The age of the patient. 

Q. If the temporary teeth are in the mouth causing 
the irregularities what should be done? 

A. They should be removed. 

Q. When the removal of the second teeth becomes 
a necessity which tooth should be sacrificed? 

A. A tooth should be selected which is the least 
prominent or which will least affect the expression. 
In selecting teeth for removal each case must be taken 
as a law unto itself requiring its own special treatment. 

Q. What is generally practicable? 
. A. A good rule is to retain, if possible, the six 
anterior teeth; as the cuspids on the upper jaw are the 
most prominent and give expression to the face, they 
should not be removed. If a tooth must be sacrificed, 
the selection lies between the first or second bicuspid 
and the first molar. 

Q. How should the teeth be removed, if at all? 



286 QUIZ COMPEND 

A. If the bicuspids be decayed they should be 
removed. If a first molar be decayed and it can be 
crowned, it should not be removed. The removal of 
a first molar will secure more room than is required. 
It has served from the sixth year, which fact — in con- 
nection with its solidity in the jaws and its central 
position, argues for its keeping. 

Q. Should the incisors ever be extracted? 

A. It occasionally happens that the articulation 
posterior to the cuspids is perfect, nearly approximat- 
ing the central and the laterals locked inside or out- 
side of the arch, whether sound or decayed, it may be 
best in such cases to remove one or both laterals. 

Q. Will the general appearance be injured? 

A. It will not. 

Q. Are the inferior incisors ever irregular? 

A. Yes. If the articulation be normal in the pos- 
terior part of the mouth almost any of the incisors that 
are out of position may. be removed. 

Q. Do they resemble each other? 

A. They resemble each other so evenly in size and 
shape and are so nearly concealed by the lip their loss 
will not be observed. 

Q. Is it necessary to be careful in selection of the 
teeth and mode of treatment in such cases? 

A. Yes. Since an actual increase of the deformity 
may be produced by a hurried operation. 

Q. May the cuspids be removed on the lower jaw? 

A. If the arch is complete with the cuspids out or 
inside they may be removed with excellent results. 

Q. Which bicuspid should be removed if necessary? 

A. The one which is the most decayed, if by so 
doing the irregularity can be corrected. 



ON IRREGULARITIES OF THE TEETH. 287 

Q. If both bicuspids be sound, which one may be 
removed? 

A. The first one if the anterior teeth are crowded. 
This makes room for the cuspid. 

Q. Is the Roentgen ray of value in diagnosis of 
tooth deformities? 

A. Nowhere in medicine is it of such importance. 

Q. Under what conditions may it be used? 

A. Delayed eruption, early extraction, abnormal 
and broken roots of teeth, location and position of 
third molars, absorption of roots of teeth and of the 
alveolar process and the roots can be easily outlined. 

Q. What affect do these conditions have upon the 
teeth? 

A. They affect occlusion and impair mastication. 

Q. How are impacted and imbedded teeth located? 

A. By cutting down upon the locality and explor- 
ing for missing teeth. This is easily done with very 
little pain to the patient. 

Q. Is it easy to obtain skiagraphs of the jaws? 

A. At the present time it is somewhat difficult for 
the reason that the jaws cannot be kept quiet. 

Q. Which teeth are the easiest? 

A. The molars and bicuspids. 

Q. If the vault be high, can better results be 
obtained? 

A. Yes. 

Q. What are some of the various methods? 

A. Dr. Kells* method is as follows: A cast is made 
of the portion of the mouth to be skiagraphed and a 
small piece of modeling compound molded over the 
crowns of the teeth thereon. 

A piece of aluminum, this metal being almost 



288 QUIZ COMPEND 

transparent to the rays, of about twenty-six or twenty- 
eight gauge, is cut to the desired size and shape and 
bent to fit the cast as well as possible. This is slotted 
along the edge toward the crowns of the teeth and 
thereby attached to the modeling compound above 
referred to. This forms a convenient little film holder, 
which when placed in the mouth will allow the patient 
to close the teeth upon it and thus hold it securely in 
position, without danger of its moving for aanuch 
longer time than is necessary to take the picture. 

The next step is to cut the plate or celluloid film, 
whichever is to be used, to the proper size and envelop 
it neatly in black paper, gluing down all the edges 
with paste and securing it to the plate holder by two 
or three small aluminum clamps. 

This is all that is usually necessary, but if it is 
deemed advisable to protect this from moisture, as is 
sometimes the case, more especially for lower teeth, 
then the black envelope is covered with thin tin foil 
or waterproof paper neatly pasted down, care being 
taken not to have the foil, if that is used, doubled upon 
the side to be exposed. While this may appear to be 
a long process, it is quickly accomplished and the 
invariably satisfactory results obtained warrant the 
trouble taken. 

The patient is then seated in a chair with a photog- 
rapher's head-rest to hold the head, the Tesla screen 
should be adjusted in place, the tube brought to 
about ten or twelve inches from the face and placed 
so as to throw the best shadow of the parts upon the 
film. The length of exposure depends upon the thick- 
ness of the parts to be penetrated, the working condi- 
tion of the apparatus and the distance of the patient 



ON IRREGULARITIES OF THE TEETH. 289 

from the tube, the time being proportional to the 
square of the distance. 

From sixty to ninety seconds are necessary for 
ordinary cases, ranging perhaps up to one hundred 
and twenty seconds for third molars in heavy jaws, 
while twenty to forty seconds are sufficient for some 
favorable cases in thinner bones. 

Q. Give Dr. J. N. McDowell's method. 

A. Dr. J. N. M'Dowell recommends the following 
method: "In taking X-rays of the teeth it was found 
impossible to conveniently cut glass sensitive plates to 
correctly fit the different parts of the mouth without 
the spoiling of many plates. To overcome this diffi- 
culty, it was necessary to have something that could 
be easily cut and shaped to fit the mouth for each 
occasion and at the same time transmit light as a 
negative in making photographs. Celluloid prepared 
with sensitive chemicals has been found to answer this 
purpose best. 

' k No special preparation of the mouth in the way of 

washes, etc., is necessary, as the plate is protected by 

a covering. Cut a piece of cardboard to fit the part of 

the mouth that is to be photographed. In the dark 

room lay the cardboard on the sensitive celluloid plate 

and cut to the same shape. Figs. 258 and 259, etc., 

of the X-ray pictures show the original shape of the 

cut celluloid. This is then wrapped in black paper to 

protect the plate from light and the moisture of the 

mouth. The head is so placed as to be immovable and 

the sensitive celluloid placed in the mouth directly 

back of the teeth to be taken. The usual time of 

exposure is about a minute with Crookes' six-inch tube. 

This tube should be stationed some six or eight inches 
23 



290 QUIZ COMPEND 

above and in front of the teeth to be taken, in order 
to secure the outlines of the roots. If the tube is held 
directly opposite the teeth the roots are not taken, as 
the plate cannot be inserted high enough, owing to 
the shape of the roof of the mouth." 

Q. What is an element in tooth regulation? 

A. The fee. ' 

Q. How is this estimated? 

A. The dentist should have so prepared himself that 
he fully understands and appreciates the requirements 
of any case which he may undertake to correct. This 
will take much time and anxious thought, for which 
he should receive just reward. 

Q. What condition of the patient should be stud- 
ied? 

A. The temperament and disposition as well as the 
ossific condition of the iaws. 

ml 

Q. What frequently happens in these cases? 

A. Mouths exhibiting very similar deformities on 
account of mental and physiologic idiosyncrasies and 
differences in density of tissue occur requiring differ- 
ent treatment and length of time to accomplish favor- 
able results. 

Q. Should there be an understanding between the 
patient and the operator as to the fee before com- 
mencing the operation? 

A. Yes, as correct an estimate should be made as 
possible. This is difficult to do, therefore maximum 
and minimum prices should be given. 

Q. What are some of the difficulties encountered in 
regulation? 

A. One of the greatest is to persuade the patient 
to submit to the annoyance of wearing the appliance, 



ON IRREGULARITIES OF THE TEETH. 291 

secondly to impress upon the patient the necessity of 
being prompt and faithful in visits to the dentist. 

Q. Do children ever become discouraged? 

A. Not appreciating the importance of these oper- 
ations, patients, especially children, frequently be- 
come discouraged and are anxious to abandon the 
treatment before completion. 

Q. Does the parent often sympathize with the child? 

A. They do, and without regard for the labor or 
expense which the dentist has assumed or the real 
interest of the patient, abandon the operation. 

Q. What is always a good plan? 

A. In every case the dentist should demand and 
receive at least one-half the proposed fee before the 
work is begun. With this money invested in the 
operation the parent will be loth to allow the case to 
be abandoned before it is finished. 

Q. What is the dentist's responsibility? 

A. With due regard to the comfort and good of his 
patient, the dentist should expedite his operation so 
that suffering and expense may be as light as possible. 
All should be done with an intelligent understanding 
of the physiologic and pathologic condition under care. 

Q. What is expected of the patient? 

A. By obedience to the dentist's instructions can 
facilitate the correction which will of course greatly 
reduce the expense of the operation. 

Q. Is it well to go into the details of the operation? 

A. Here as elsewhere in surgery, it is better not to 
give too minute details as to plans to be followed and 
the appliances used, since it frequently happens that 
the most carefully planned procedure has to be varied 
during the operation. 



292 QUIZ COMPEND 

Q. What effect does this have upon the patient? 

A. In this case disappointment and dissatisfaction 
may be engendered in the mind of the patient or 
relatives with a suspicion as to the dentist's ability to 
accomplish the results. 



CHAPTER XXXL 



PHYSIOLOGIC AND PATHOLOGIC CHANGES. 

Q. What elements of change enter into the 
alveolar process? 

A. Development and absorption in its relation to 
eruption and loss of the teeth. 

Q. What is the function of the process? 

A. The process is to support the teeth while in 
place and finally after their removal it is lost. 

O. What should this tissue be called? 

A. Transitory. The osteoblasts and osteoclasts 
are always present to build up or tear down structure 
as may be required, by the exigency of environment 

Q. What other factor increases the transitory 
nature of the alveolar process? 

A. Evolution of the jaws. 

Q. Do these osteoblasts and osteoclasts act rap- 
idly? 

A. Their rapidity of action depends upon age and 
the condition of the system. 

Q. When is the most active period? 

A. During youth. 

Q. What causes the activity? 
. A. The vascularity and want of density of bone 
structure. 

Q. What will produce absorption of the process? 

A. Light constant pressure. 

Q. Are teeth constantly changing their positions? 

293 



294 QUIZ. COMMEND 

A. Absorption and deposition of bone is going on 
simultaneously and continuously. 

Q. When is this especially noticeable? 

A. At the first eruption of the teeth. Again, when 
the first permanent molar has been removed and the 
second and third molars have moved forward and 
filled the space. Teeth that have erupted out of their 
position will often find their way back into place. 

Q. Can the teeth be placed in their proper posi- 
tions by mechanical devices? 

A. By removing obstruction, regulation of malpo- 
sition becomes simple. 

Q. Can absorption be hastened? 

A. Equable reproduction and absorption will 
depend upon the amount of pressure exerted and the 
condition of the individual. In cachexiae disintegra- 
tion is favored while tissue building is retarded. 

Q. In what conditions is tissue building retarded? 

A. This notably occurs in auto-intoxication and 
senile absorption. 

Q. What must be taken into consideration in ap- 
plying pressure? 

A. The degree of pressure and the constitutional 
condition of the patient. 

Q. How must pressure be applied? 

A. It must be evenly distributed and constant, 
pain will not be experienced when once the teeth 
begin to yield. 

Q. What will happen if the force be not constant? 

A. When the force is applied, removed and reap- 
plied spasmodically pain necessarily results. 

Q. Illustrate the two methods. 

A, When teeth have been separated to facilitate 



ON IRREGULARITIES OF THE TEETH. 295 

the filling of proximate cavities, tooth vibration due 
to preparing the cavities and application of gold pro- 
duces an intense pain relieved by inserting a wedge to 
steady the teeth, when no pain will be felt. 

Q. Does increased pressure imply greater pain? 

A. It does, especially when alveolar process hyper- 
trophy is present. 

Q. Is hypertrophy very common? 
. A. It is. The operator must be on the alert to 
discover its location at the outset of the operation 
because heavier appliances and unusual pressure are 
required to produce bone absorption. 

Q. What should be done in such cases? 

A. Cutting away the alveolar process is always 
indicated. 

Q. What effect does it produce? 

A. It relieves the strain upon the nervous system. 

Q. What causes pain? 

A. The pressure of the tooth upon the alveolar 
process sets up inflammation. When the pressure is 
greater than the absorption pain results, or where the 
pressure is intermittent pain ensues. 

Q. What was once supposed to be the sole type of 
bone absorption? 

A. Osteoclast or lacunar absorption. 

Q. To what may bone absorption be due? 

A. It may be due to either lacunar or osteoclast, 
halisteresis, Volkmann's perforating canal or osteoma- 
lacia (or senile) absorption. 

Q. What is lacunar or osteoclast absorption? 

A. Lacunar or osteoclast absorption depends on 
large specialized cells which liquefy bone and are situ- 
ated in Howship's lacunae, 



298 • QUIZ COMPEND 

Q. What is halisteresis absorption? 

A. Halisteresis (from the Greek meaning salt 
deprivation or decalcification) arises in irritation and 
inflammation in the Haversian canals. As the salts 
are absorbed, commencing at the canal margins these 
enlarge. 

Q. To what is Volkmann's perforating canal ab- 
sorption due? 

A. To irritation and inflammation set up' in the 
blood vessels of Von Ebner causing absorption of the 
bony walls which perforate the bone from one part to 
another. 

Q. What is osteomalacia or senile absorption? 

A. It is called juvenile when it occurs during 
pregnancy. The senile type may occur at any period 
of stress. It is a morbid decalcification whose origin 
is at present unknown. It has been charged to many 
causes; to lactic acid, to increased amount of carbonic 
acid in the blood. According to Eisenhart it is due to 
diminished alkalinity of the blood. According to Von 
Recklinghausen it is due to irritation of the vascular 
mechanism of the bones. Talbot is of the opinion that 
it is due to auto-intoxication. 

Q. How were these different absorptions shown to 
occur in regulation of teeth? 

A. By experiments made upon dogs. 

Q. How was this done? 

A. Impressions of the mouth were taken in mod- 
eling compound. Models were secured and caps of 
German silver were made for the cuspid teeth. A 
jackscrew was soldered to the caps with soft solder. 

Q. How w r ere the appliances fastened to the teeth? 

A. The dogs were securely fastened into a V-shaped 



ON IRREGULARITIES. OF THE TEETH. 297 

box with cotton bandages. When chloroformed the 
appliances were placed upon the teeth and cemented 
into place. 

Q. How was the dog prevented from removing 
the appliance? 

A. A -muzzle was placed upon the head and the 
fore feet tied with cotton bandages to prevent removal 
of the appliances.. The muzzle and bandages were 
removed twice a day for the purpose of feeding. 

Q. How often was the screw turned? 

A. The screw was given one-fourth, one-half and 
one full turn every day. The screws were sixty 
threads to the inch. The teeth of three dogs were 
moved 1-240, 1-120 and 1-60 of an inch respectively per 
day as suggested by Farrar. 

Q. How long was the muzzle allowed to remain? 

A. At the end of three days the muzzle and leg 
bands could be removed, the dogs having become 
accustomed to the appliance. In the cases where the 
screw was turned one-fourth and one-half per day, was 
continued for seven days. In those in which the 
screw was given a full turn it was continued for two 
weeks, the object being to set up pathologic changes 
in the alveolar process. The dogs were killed at the 
end of the periods mentioned. 

Q. How were the jaws prepared? 

A. The jaws were placed in sixty-five per cent, 
alcohol for twelve hours, then in absolute alcohol for 
forty-eight hours. They were then transferred to 
five per cent, nitric acid and water. This was changed 
every two days for a week or until the tissues became 
so soft as to be easily penetrated by a pin. They 
were then placed in running water to remove acid. 



< 



298 QUIZ COMPEND 

This took from twelve to twenty-four hours. The 
tissues were then placed in sixty-five per cent, alcohol 
six hours; then in ninety-five per cent, six hours, and 
then in absolute alcohol twenty-four hours. The 
tissues were then imbedded in thin celloidin twenty- 
four hours, then in thick celloidin twenty-four hours. 
They were then mounted on blocks of wood and har- 
dened in eighty per cent, alcohol from six to twenty- 
four hours. The specimens were cut, stained in 
haematoxylin, eosin. 

Q. What had occurred in the cases when the 
screw was turned one-fourth turn? 

A. The inflammatory process had commenced 
around the Haversian canals with halisteresis and 
osteoclast or lacunar absorption, medullary cavities 
arising from absorption of the trabeculae. 

Q. What was the difference between cases where 
the screw was turned one-half turn each day and 
those turned only one-fourth turn? 

A. The results were about the same, only more 
intensified, round cell infiltration was quite marked. 
The medullary cavities are larger. 

Q. Were there any marked changes in those cases 
where the teeth were given a full turn in fourteen days? 

A. All conditions noticed in the other slides were 
prominent. Volkmann's perforating canals were 
marked. 

Q. What is the difference between the absorption 
of the alveolar process from movement of the teeth 
and interstitial gingivitis? 

A. The absorption is precisely the same. 

Q. Does absorption of the alveolar process in the 
eruption of the teeth differ? 



ON IRREGULARITIES OF THE TEETH. 299 

A. No. A young monkey died from burns. The 
upper cuspids were erupting. The temporary cuspids 
were still in place. The jaws were prepared in the 
usual way for the microscope. The slides show like 
results. 

Q. If absorption of bone in such conditions be 
inflammatory, what is the process of absorption of the 
alveolar process when the teeth are removed? 

A. In moving the teeth of dogs, only the upper 
jaw was used. Teeth on the lower were extracted to 
note the change in the alveolar process. The teeth 
had been extracted seven days. Active round cell 
inflammation occurred in and about the Haversian 
canals, osteoclast absorption, Volkmann's perforating 
canal absorption and absorption of the trabeculse was 
also present. 

Q. What is the common opinion as to absorption 
of bone, especially in regulating teeth? 

A. That it was osteoclast or lacunar absorption, 
and that if pressure was greater than the tissues could 
stand, inflammation set in and absorption ceased. 

Q. What do these investigations show? 

A. Careful study of the process of absorption 
reveals that different results could hardly be expected 
in tooth movement. The surroundings of the alveolar 
process are the same in all cases. Absorption is the 
same, though the propelling forces be different — inter- 
stitial gingivitis, irritation, screw pressure, the eruption 
of a tooth and the extraction of a tooth — in every case 
the absorption takes place by inflammation. 

Q. In rotating teeth, does absorption take place? 

A. To a slight extent inflammation takes place. 
The fibers elongate and take the direction of the tooth. 



300 QUIZ COMPEND 

Q. Does pressure upon the tooth detach the peri- 
dental membrane? 

A. It does not. 

O. What becomes of the fibrous tissue when teeth 
are moved in straight lines or rotated? 

A. The fibers stretch. If pressure be removed, 
the elasticity of the tissues returns the tooth to its 
original position. 

Q. What change occurs when a tooth has been 
forced into a new position? 

A. The fibrous tissue is reinforced by new tissue. 
Osteoblasts build up new bone and in this way the 
teeth are held in their new position. 

Q. If the alveolar process has obtained its growth 
or if the fibrous tissue (trabecule) is destroyed, what 
are the chances of restoration? 

A. They are very slight. 

Q. In the light of these experiments and the ease 
with which inflammation and absorption are produced, 
can the alveolar process be bent in regulation? 

A. It is doubtful if such a thing be possible. In 
any case, should the process yield to pressure, absorp- 
tion must continue until the pressure is relieved. 

Q. Is not the continuous pressure, producing in- 
flammation in children whose nervous systems are 
unstable, pernicious practice? 

A. It is not good practice to cause continuous pain 
for any length of time by forcing the teeth through 
the alveolar process when it can be accomplished by 
the much more rapid scientific method of cutting away 
the bone. 

Q. How does osteomalacia or senile absorption 
affect the alveolar process. 



ON IRREGULARITIES OF THE TEETH. 301 

A. While other forms of absorption must await 
the onset of the inflammatory process, osteomalacia or 
senile absorption sooner or later ensues in every indi- 
vidual. 

Q. Why is this? 

A. Instability of the alveolar process renders this 
a normal absorption. 

Q. To what is this absorption due? 

A. It is readily produced by slight irritation like 
heat, auto-intoxication, drugs, etc. It naturally 
occurs after the process has obtained its growth. 

Q. When does it occur at an early period? 

A. When pathologic factors such as malnutrition, 
drugs, etc., suffice to overcome cell building. 

Q. Does the unstable nature of the alveolar pro- 
cess render interstitial gingivitis common? 

A. It may be found in almost every mouth, par- 
ticularly neurotics and degenerates. 

Q. To correct irregularities of the teeth, should 
the operator understand the laws of degeneracy? 

A. He should. Rapidity in irregularity correction 
implies lack of knowledge of the structures upon which 
he operates. 

Q. Is it good practice to move the tissues rapidly? 

A. No. If force be so great as to destroy the 
trabecule, tissue building cannot restore the process. 
If great but not steady pressure be applied, and if 
nutriment be poor, the alveolar process will not be 
restored. 

Q. Should teeth be regulated in persons whose 
nutrition is poor? 

A. No. Malnutrition of the alveolar process 
should preclude operation, or if it must be performed, 



302 QUIZ COMPEND 

slow, steady pressure should be used to prevent 
excessive interstitial gingivitis. Patients with scrofu- 
lous, syphilitic or tubercular tendencies should be 
treated with great consideration. 

Q. Should many teeth be treated at a time in 
such cases? 

A. No; one or two only. 

Q. Should teeth be regulated late in life? 

A. Only in emergencies. The results are in pro- 
portion to the strain upon the system. The tendency 
is toward osteomalacia, although other forms of 
absorption may occur. Permanent absorption may 
ensue. 

Q. Should extended operations be performed late 
in life? 

A. No. Even if successful and if the teeth be 
retained in their positions, the alveolar process cannot 
be depended upon to remain throughout life. The 
older the patient, the greater the pressure required, 
the greater the amount of inflammation set up and the 
less chance of success. 

Q. From the transitory nature of the jaws and the 
alveolar processes, the density of bone in hypertrophy, 
the terminal structure and the ease with which inflam- 
mation and absorption ensue, when and how is regula- 
tion of teeth justified? 

A. The cutting away of the alveolar process will 
relieve excessive pressure, reduce the inflammation to 
a minimum and prevent extensive absorption. Cor- 
rection of the teeth at all periods produces structural 
change in the alveolar process, the extent of this ever 
remains a predisposing factor to interstitial gingivitis. 



CHAPTER XXXIL 



SURGICAL CORRECTION. 

Q. What science does surgical correction of deform- 
ities of the jaws resemble in its relation to dentistry? 

A. Orthopedic surgery. 

Q. Is deformity correction a necessary result of 
dental practice? 

A. It is not. Special training is needed for its 
practice. 

Q. What is required? 

A. The person who practices surgical correction of 
the jaws and teeth should have mechanical ingenuity, 
be familiar with mechanical movements, and well 
versed in pathology; in fact, medically educated. 

Q. Can fixed systems of appliances be depended 
upon for the purpose of correcting a given line of 
cases? 

A. Only partially. 

Q. Is the claim that appliances rapidly and success- 
fully hasten correction absolutely true? 

A. No. Centuries of experience in surgery have 
demonstrated that appliances must be adapted to the 
case and not the case to the appliances. 

Q. Is it expedient to keep certain parts on hand? 

A. Certain simple pieces may be kept on hand to be 
attached to parts formed to the case, but even these 
must be adjusted to the special case. 

Q. Is not such teaching misleading? 

m 



304 QUIZ COMPEND 

A. The victim of such teaching frequently fails in 
his cases by relying too much upon a "system" rather 
than upon general principle. 

Q. Do appliances frequently have to be changed? 

A. One kind of appliance may be used to start the 
operation, but the skilled, unbiased operator is forced 
to observe that a different appliance can be used to a 
better advantage, especially in connection with one 
already in use. 

Q e Will a specialist who confines himself to a sys- 
tem ever become a skilled operator? 

A. No. 

Q. Taking the constitution and health into consid- 
eration, will one set of appliances always answer in 
similar cases? 

A. An appliance theoretically adapted to a given 
case may be wholly unfit because of the patient's 
physical condition. An appliance suitable to one 
period in life will not be to another. 

Q. What is necessary to obtain the best results as 
to mechanical force? 

A. A knowledge of the mechanical forces, their 
powers and limitations of ease, and the methods of 
application. 

Q. How do all forces act? 

A. They act either continuously like the lever or 
interruptedly like the screw, but in either case their 
action diminishes with the yielding of the tooth. 

Q. Of what modifications are all the mechanical 
powers? 

A. They are modifications of two primary princi- 
ples, the inclined plane and the lever. From these 
other forces are derived. 



ON IRREGULARITIES OF THE TEETH. 305 

Q. What are the forces? 

A. The screw, the lever, the pulley, wheel and 
axle, the inclined plane, the wedge, and elasticity. 

Q. Can all of these forces be applied in regulation? 

A. All of these forces have their places in the cor- 
rection of deformities of the jaws and teeth. Appli- 
ances cannot be made which do not include one or more 
of these forces, and all forces maybe successfully used 
in regulation. 

Q. How should they be taught? 
. A. Principles rather than systems. Each may be 
used to a good advantage in given cases when judg- 
ment has been employed in selection and adjustment 
and in adopting the methods of using them. 

Q. Having the foundation principles of force and 
its application to the teeth, can the operator select the 
force necessary? 

A. With these laws and their application firmly 
fixed in mind the operator can select the one which 
should properly be applied or if more than one is nec- 
essary can so combine them as to accomplish the 
desired result. 

Q. What will aid in the selection of appliances? 

A. The degree and line of force. 

Q. What is the object of an appliance? 

A. Every appliance for regulation of the teeth 
aims at the object to exert pressure upon the teeth to 
be moved. 

Q. Of what should an appliance consist? 

A. An appliance for this purpose should be small 
as compatible with effectiveness and strength. It 
should be so constructed it can be applied inside of the 
arch in such a manner it will not interfere w r ith speech 



306 QUIZ COMREND 

or mastication, and can be removed for cleansing as 
far as possible. It should give as little annoyance as 
possible and should not necessitate frequent visits to 
the dentist for adjustment. 

Q. What must always be considered in regula- 
tion? 

A. Whether the teeth be forced out or drawn in, 
there must always be considered a body to be moved 
(the tooth) and a fixed point of resistance. 

Q. Does the study of the models always determine 
the amount of force required? 

A. It does not, although models should be studied. 
While a point opposite can be chosen for anchorage 
of the appliance, this is not always true. Each case is 
a problem in itself. 

Q. Which must be the strongest, the point of an- 
chorage or the point to be moved? 

A. The point of anchorage must offer greater 
resistance than the point to be moved. 

Q. Is it sometimes difficult to find such a point? 

A. Yes. Especially the case when a cuspid is to 
be moved. 

Q. Does it happen that the opposite is accomplished 
to what was anticipated? 

A. It frequently happens that the dentist finds to 
his chagrin he has moved his point of resistance 
rather than the tooth. Constant vigilance must hence 
be exercised in noting occlusion. 

Q. While the operation is under way, what is a 
good plan to do? 

A. The patient should be asked at each sitting, in 
which tooth he suffers most when the nut is turned, if 
a screw be used, 



ON IRREGULARITIES OF THE TEETH. 307 

Q. What is a good practice when teeth to be moved 
possess great resistance? 

A. In moving teeth that afford great resistance, it 
is often best to loosen first by simple wedging with 
orange wood or even cotton, proceeding slowly. 

Q. What effect does this have? 

A. This causes inflammation, then absorption of 
the alveolar process around the tooth or teeth to be 
moved, giving the tooth decided advantage over the 
fixed point when force is applied. Thus resistance is 
lessened and the tooth or teeth to which the appli- 
ances are attached will now afford greater resistance 
in proportion than at first. 

Q. Is it ever desirable to construct a plate or com- 
bine two or more teeth for a fixed point? 

A. This is desirable (i) where there is not a tooth 
conveniently located for attachment, (2) where it is 
expedient to avoid the additional irritation, (3) where 
the mechanism is such as to require it. 

Q. What should be considered in adjusting the 
appliance to the tooth? 

A. Its position in the jaw should be observed and 
the inclination of the root or roots must be ascertained 
to decide whether they stand perpendicularly in the 
alveolar process or on an incline. 

Q. Should obstructions be removed? 

A. Obstructions should be removed by extraction 
or by lateral pressure. 

Q. How should the force be applied? 

A. The force should be applied to the tooth to be 
moved either at right angles to the long axis of the 
root or at an angle of forty-five degrees. 

Q. What benefit is derived by this method? 



308 QUIZ COMPEND 

A. The tooth is prevented from rising from the 
socket. 

O. Should holes be drilled in the teeth for an- 
chorage? 

A. Most cases can be treated by securing a band or 
cap of thin gold or platinum to the teeth with zinc 
oxyphosphate, in which bands holes may be drilled or 
hooks or loops or tubes soldered at any required point. 

O. How should the force be applied? 

A, If possible the force should be uniform and 
steady, but this while possible with certain appliances 
like elastic bands, ligatures, strings and the like, is 
impossible with the screw. 

Q. How do these. forces act? 

A. All forces act either slowly and constantly like 
the above, diminishing in their action in proportion to 
the yielding of the tooth, or else they act by impulse 
like the screw. 

O. How much pressure should be applied? 

A. The force exerted should be enough to produce 
inflammation and absorption of bone. Too rapid 
movement of the teeth, especially in patients over 
twenty years of age, is unadvisable. Extensive 
inflammation from extreme force required prevents 
restoration of bone. 

Q. When great pressure is required, are not the 
appliances unsightly and inconvenient? 

A. Appliances adjusted to the head are then so un- 
sightly and embarrassing t ] ~at the patient is deterred 
from an operation which could otherwise have been 
undertaken had some method been adopted that would 
not detract from personal appearance. 

Q. When appliances are attached to the molars for 



ON IRREGULARITIES OF THE TEETH. 309 

the purpose of moving the cuspids and incisors back- 
ward, do the molars often move forward instead? 

A. Very often. 

Q. What are difficult problems to solve? 

A. How to carry a cuspid into place that has 
erupted in the vault or an inferior cuspid that is out- 
side and forward of its normal position back into place. 
The rotation of teeth, especially the incisors and cus- 
pids. Movement of teeth through hypertrophied 
alveolar process. Many other situations present 
themselves other than those mentioned. 

Q. Are the present methods scientific? 

A. The long, tedious methods of plowing through 
the alveolar process regardless of the density of bone 
by absorption is pernicious and implies tedious days, 
weeks and months of suffering. 

Q. Should not methods be employed which avert 
strain upon the nervous system at the periods of 
stress? 

A. The periods most acceptable for the correction 
of these deformities are at twelve to sixteen years of 
age. This time is the most critical in the patient's 
life. Nervous prostration of years standing may 
result and the patient be permanently injured by such 
nerve strain. 

Q. How can operations in these cases be made easy? 

A. To obviate excessive pressure as well as un- 
sightly appliances, after the appliance has been 
adjusted (no matter of what nature) and pressure 
applied, proceed . as follows: Remove the alveolar 
process in the line of travel of the tooth to be moved, 
leaving a small amount about the tooth root holding 
intact the peridental membrane. 



310 QUIZ COMPEND 

Q. How is this accomplished? 

A. By using round, coarse-cut engine burs, or 
those which cut in all directions. They can be used 
as drills. If a cuspid requires to be carried back- 
ward, extract the first bicuspid and adjust the appli- 
ance. Then resting the thumb against the cuspid, cut 
out the lingual and buccal V-shaped plate, making a 
concave surface of the alveolar process. 

Q. How can the incisors be carried back? 

A. Cut semi-circular spaces just posterior to the 
teeth to be moved. 

Q. What procedure is to be adopted in carrying a 
cuspid into place which has erupted in the vault? 

A. Remove the alveolar process in the direction of 
the line of travel. 

Q. In moving teeth laterally by the jackscrew when 
one tooth moves faster than the other, how should 
this be adjusted? 

A. To bring both into their proper positions, cut 
out the alveolar process in front of the slowest moving 
tooth. 

Q. How should a tooth be rotated? 

A. Cut a circular groove as deep as possible around 
the tooth, leaving enough process to hold the peri- 
dental membrane intact. In this manner teeth can be 
moved rapidly and comparatively without pain. 

Q. What appliance should be used in such opera- 
tions? 

A. The screw, by this appliance the teeth are com- 
pletely under control. 



MOV 26 1801 



NOV 25 1901 



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